Kosin Med J.  2019 Dec;34(2):152-160. 10.7180/kmj.2019.34.2.152.

Treatment of Isolated Sternal Fracture with Ultrasound-Guided Paravertebral Nerve Block: a Case Report and Literature Review

• Park JM
• Kim H

• KMID: 2467976
• DOI: http://doi.org/10.7180/kmj.2019.34.2.152

Abstract

In the case of isolated sternal fractures, conservative treatment with analgesics is common, but pain can persist for more than 10 weeks, which can significantly interfere with daily life. Ultrasound-guided paravertebral nerve block is reported to be a successful means of pain control in patients with chest wall injury or rib fracture. A 70-year-old female patient presented with anterior chest pain that had persisted for 2 weeks despite conservative treatment. Sagittal reconstruction chest computed tomography and sternum lateral oblique x-ray revealed an isolated sternal fracture. An ultrasound-guided bilateral paravertebral nerve block was performed for pain control. After performing the procedure twice at a 1-week interval, the patient reported complete pain alleviation, and no other problems were observed over the 3-month follow-up period. Ultrasound-guided bilateral paravertebral nerve block can help patients with isolated sternal fractures to manage pain and return to normal activities sooner than with oral analgesics.

Keyword

Fracture; Nerve block; Pain management; Sternum; Ultrasonography

MeSH Terms

Aged
Analgesics
Chest Pain
Female
Follow-Up Studies
Humans
Nerve Block*
Pain Management
Rib Fractures
Sternum
Thoracic Wall
Thorax
Ultrasonography
Analgesics

Figure

• 

  Fig. 1 (A) Sternum lateral oblique x-ray. (B) Sagittal reconstruction chest CT. Arrows indicate fracture site.

• 

  Fig. 2 (A) C-arm view showing the direction of the third and fourth ribs. (B) Skin was marked along the running direction of the third and fourth ribs. (C) Curved transducer was placed parallel to the direction indicated on the skin and moved medially and laterally along the skin markings and cephalad and caudally to locate the thoracic paravertebral space for injection.

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  Fig. 3 (A) Ultrasound view showing the ribs were excluded from the path of the needle. (B) Ultrasound view showing anterior movement of the parietal pleura (small arrow). T: target region, TP: transverse process, needle (arrow head), tip of needle (large arrow).

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