Journal of Anesthesia

, Volume 30, Issue 5, pp 916–916 | Cite as

Ultrasound-guided parasternal intercostal nerve block

  • Yuichi Ohgoshi
  • Kentaro Ino
  • Masakazu Matsukawa
Letter to the Editor


Parasternal intercostal nerve block Transversus thoracic muscle plane block Mastectomy PECS 

To the Editor:

Recently, transversus thoracic muscle plane block (TTP block) has been reported to block anterior branches of intercostal nerves [1]. TTP block combined with pectoral nerve II (PECS II) block [2] provide effective analgesia for the total mastectomy.

However, there are some technically difficult points in the TTP block. Firstly, it is sometimes difficult to detect the transversus thoracic muscle by ultrasound because this muscle is so small. Secondly, we need very good needling techniques to perform the TTP block safely because the pleura and the internal thoracic artery are located in the immediate vicinity of the plane.

We propose a simple and secure technique for blocking multiple anterior branches of intercostal nerves, named the parasternal intercostal nerve block (PSI block). To perform a PSI block, we inject a local anesthetic between the pectoral major muscle and the external intercostal muscle (Supplementary Figure). Because anterior branches of the intercostal nerve penetrate through these two muscles to innervate the internal mammary area, injection of a local anesthetic to this plane could block anterior branches of intercostal nerves.

Supplementary material

540_2016_2202_MOESM1_ESM.jpg (26 kb)
A) Ultrasound transversal view of the intercostal space. To perform PSI block, a local anesthetic is injected into the plane between the pectoral major muscle and external intercostal muscle. PM pectoral major muscle, IM intercostal muscle, S sternum. B) Ultrasound sagittal view of the intercostal space. R rib. C) Spread of a local anesthetic. Twenty milliliters of local anesthetic injected into the intercostal space (*) spreads into the next intercostal space (**) (JPEG 26 kb)


  1. 1.
    Ueshima H, Kitamura A. Blocking of multiple anterior branches of intercostal nerves (Th 2-6) using a transversus thoracic muscle plane block. Reg Anesth Pain Med. 2015;40:388–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Blanco R, Fajardo M, Parras Maldonado T. Ultrasound description of Pecs II (modified Pecs I): a novel approach to breast surgery. Rev Esp Anestesiol Reanim. 2012;59:470–5.CrossRefPubMedGoogle Scholar

Copyright information

© Japanese Society of Anesthesiologists 2016

Authors and Affiliations

  • Yuichi Ohgoshi
    • 1
  • Kentaro Ino
    • 1
  • Masakazu Matsukawa
    • 1
  1. 1.Department of AnesthesiologyInternational University of Health and Welfare Mita HospitalTokyoJapan

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