Pain Management Procedures
Pectointercostal and Serratus Anterior Plane Blocks
Pectointercostal and Serratus Anterior Plane Blocks
What are they?
These ultrasound-guided fascial-plane blocks spread local anesthetic between chest-wall muscles to numb several small nerve branches. A pectointercostal block targets the front chest wall near the breastbone. A serratus anterior plane block targets the side of the chest near the ribs and armpit.
When may they be recommended?
They are commonly used to reduce pain around breast, chest-wall, or cardiac procedures and may be considered for selected rib or chronic chest-wall pain. The painful area must match the nerves covered. New chest pain needs appropriate medical evaluation before it is treated as a chest-wall problem.
What happens?
You lie on your back or side. Ultrasound shows the ribs, muscles, pleura, and blood vessels. A needle is advanced into the chosen tissue plane, and local anesthetic is injected while the clinician watches it separate the layers.
What should I expect?
The front or side of the chest may feel numb for hours. Relief may cover several rib levels but does not treat pain from an internal organ. Protect numb skin and follow instructions about activity.
Important risks
Risks include bleeding, infection, local-anesthetic toxicity, incomplete block, vascular injury, and pneumothorax. Pectointercostal targets are also near internal thoracic vessels and the pericardium. New shortness of breath, severe chest pain, or faintness requires emergency care.
Preparing for your injection procedure…
Your instructions will depend on the procedure. Before any injection, tell the APG team if you:
Take aspirin, warfarin, clopidogrel, apixaban, rivaroxaban, or another medicine or supplement that affects bleeding. Never stop a prescribed blood thinner unless the clinician who manages it and the procedure team tell you how to do so safely.
Have diabetes, glaucoma, a bleeding disorder, an active infection, fever, or recent antibiotic treatment.
Could be pregnant, have an allergy to contrast dye or local anesthetic, or have reacted to steroid injections before.
Use an implanted pacemaker, defibrillator, spinal cord stimulator, or other electrical device.
Some procedures require fasting, a medication adjustment, or a responsible adult to drive you home, especially when sedation is planned. Follow the instructions provided for your specific appointment.
After your injection procedure…
Most injections are outpatient procedures. Mild soreness, bruising, temporary numbness, or a brief increase in the usual pain can occur. Follow the activity and bandage instructions you receive. Steroid medicine may take several days to have an effect and can temporarily raise blood sugar.
Call the office promptly for increasing redness, drainage, fever, severe or rapidly worsening pain, or new numbness or weakness. Seek emergency care for trouble breathing, chest pain, sudden loss of bladder or bowel control, a severe new headache, loss of vision, stroke-like symptoms, or rapidly progressing weakness.
This information is for general education and does not replace medical advice, diagnosis, or treatment. Not every procedure is appropriate for every patient, and results vary. Your APG care team will review your symptoms, examination, imaging, medical history, medications, and prior treatment before recommending a plan. Coverage requirements also vary by insurance plan.