Pectoral-Intercostal Fascial Plane Block for the Management of Resistant Chronic Post-sternotomy Pain Syndrome

Chronic post-sternotomy pain syndrome (PSPS) is a common complication following cardiac surgery performed through a median sternotomy. Persistent parasternal pain often resists standard multimodal pharmacological therapy and impacts quality of life. The pectoral-intercostal fascial plane block (PIFB) is an ultrasound-guided regional anesthesia technique targeting the anterior cutaneous branches of the thoracic intercostal nerves. It may provide adequate analgesia in post-sternotomy pain. A 59-year-old man presented with severe parasternal and chest wall pain five months after coronary bypass surgery. The pain was sharp, burning, and tingling, worse at night and with movement. Examination showed parasternal tenderness with allodynia. The numerical rating scale (NRS) score was 8/10, and the PainDETECT score was 17/35, indicating neuropathic pain. After six weeks of conservative treatment, pain relief was 30%. An ultrasound-guided bilateral PIFB was performed. The patient's NRS score decreased to 1/10 post-procedure. At one- and three-month follow-up, he reported 80% pain relief and improved sleep and function, without complications. This case highlights ultrasound-guided PIFB as an effective intervention for resistant chronic PSPS. Given its superficial approach, simplicity, and safety profile, PIFB may be a valuable adjunct to multimodal pain management in selected patients and merits further evaluation in larger studies.