Ultrasound-Guided Nerve Blocks for Chest

The use of ultrasound-guided technology has allowed for faster sensory block onset, fewer vascular punctures, faster performance time, and fewer needle passes in upper extremity blocks. Ultrasound-guided regional anesthesia has also reduced the incidence of local anesthetic systemic toxicity by up to 65% compared to other nerve localization techniques. Multiple techniques including nerve stimulation and injection pressure monitoring devices have been used as adjuvant techniques to assist in achieving minimal complications during ultrasound-guided injections. Although initially chest wall blocks were intended for breast surgery analgesia, Pecs and serratus plane blocks have also proven to be effective analgesia options following thoracotomy and rib fractures. Additionally, pecs blocks have been proposed as alternative technique to anesthetize operative regions that are not innervated by the brachial plexus including the axilla, proximal medial upper arm, anterior shoulder, and posterior shoulder. The possibilities for novel chest wall block indications with less risks/complications than traditional options are numerous, and the technology and technique safety of these procedures are continuing to advance.