Novel block and new indication: Ultrasound-guided continuous "mid-point transverse process to pleura" block in a patient with multiple rib fractures

Saudi J Anaesth. Oct-Dec 2019;13(4):365-367. doi: 10.4103/sja.SJA_773_18.


To avoid the complications related to thoracic epidural and paravertebral block, we performed mid-point transverse process to pleura (MTP) block in a patient with multiple rib fractures. A patient with 2nd--5th rib fractures came with complains of severe pain and difficulty in breathing. Ultrasound (US)-guided continuous MTP block was given at T4 level and 15 ml of 0.375% ropivacaine was deposited, followed by the catheter insertion at the same level. Patient reported decreased sensation from T2--T8 dermatomes and reduced VAS scores from 9/10 to 1/10 within 20 min of block insertion. Continuous MTP block is efficacious in providing thoracic analgesia and has higher safety margin as needle is inserted further away from pleura.

Keywords: Mid-point transverse process to pleura; multiple rib fractures; pain; thoracic epidural.

Publication types

  • Case Reports