Chest wall fascial plane blocks

Block	Key points
PECS I	Blocks medial and lateral pectoral nerves Local anesthetic is deposited between pectoralis major and pectoralis minor muscles at the level of the third rib Provides analgesia to the upper anterolateral chest wall
PECS II	Blocks lateral cutaneous branches of intercostal nerves approximately T2–T6 (long thoracic and thoracodorsal nerves) Local anesthetic is deposited between pectoralis minor and serratus anterior muscles at the level of the third rib Provides analgesia to the upper anterolateral chest wall
SAP	Blocks lateral cutaneous branches of intercostal nerves approximately T3–T9 (long thoracic and thoracodorsal nerves also if superficial SAP) Local anesthetic can be deposited above or below the serratus anterior muscle at the level of the fourth to fifth ribs Provides analgesia to the lateral chest wall
PIF/TTMP	Block anterior cutaneous branches of intercostal nerves PIF: local anesthetic is deposited between the pectoralis major and intercostal muscles TTMP: local anesthetic is deposited between internal intercostal and transversus thoracic muscle Provide analgesia to the anterior (parasternal) chest wall
ESP	Blocks spinal nerve dorsal and ventral rami With injection ventral to the ESP muscle at the level T5, block from T2 to T9 is expected Provides analgesia to the anterior, lateral, and posterior chest wall

PECS I: pectoralis I; PECS II: pectoralis II; SAP: serratus anterior plane; PIF: pectointercostal fascial; TTMP: transverse thoracic muscle plane; ESP: erector spinae plane.

From: Kelava M, Alfirevic A, Bustamante S, et al. Regional Anesthesia in Cardiac Surgery: An Overview of Fascial Plane Chest Wall Blocks. Anesth Analg 2020; 131:127. DOI: 10.1213/ANE.0000000000004682. Copyright © 2020 International Anesthesia Research Society. Reproduced with permission from Wolters Kluwer Health. Unauthorized reproduction of this material is prohibited.

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Chest wall fascial plane blocks