Chronic sternal pain relief after a pecto-intercostal fascial plane block: A case report

Chronic sternal pain is relatively common in adults and particularly in patients after surgery involving the chest wall such as with cardiac surgery or mastectomy. Treatment options for patients with chronic sternal pain have largely consisted of physical therapy and oral medications. The pecto-intercostal fascial plane block, while having proven efficacy in managing pain in the perioperative setting, has very limited evidence demonstrating its use within the outpatient setting.

This is a case of a 53-year-old female with chronic underlying sternal pain presumably from costochondritis who underwent radical bilateral mastectomy and radiation therapy for breast cancer, which significantly worsened her sternal pain. She failed conservative measures. A pecto-intercostal fascial plane block was ordered and administered. This brought 80-100 % pain relief and significant functional improvements for the patient which lasted for over three months.

This is a novel case where a patient with chronic sternal pain which worsened after bilateral mastectomy received a pecto-intercostal fascial plane block and had almost complete pain relief for over a three month period. Additional research is needed to further establish this procedure and its efficacy in managing patients in an outpatient setting with chronic sternal pain.