CPT® Code 64467

1. Indications

The thoracic fascial plane block is indicated for patients undergoing chest surgery who require effective post-operative pain management. The procedure is particularly beneficial for those who may be at risk of opioid-related side effects or complications. The following conditions and symptoms may warrant the use of this block:

• Post-operative Pain Management Effective control of pain following thoracic surgical procedures.
• Reduction of Opioid Use Minimizing the need for opioid analgesics in the post-operative setting.
• Thoracic Surgery Patients undergoing various types of chest surgeries, including but not limited to lobectomies, mastectomies, and other thoracic interventions.

2. Procedure

The procedure for performing a thoracic fascial plane block involves several critical steps to ensure accurate placement and effective pain relief. The following steps outline the process:

• Step 1: Imaging Guidance The procedure begins with the application of ultrasound imaging to visualize the target area on the chest wall. The ultrasound transducer is placed over the designated anatomical site, allowing the clinician to identify the relevant structures and layers of the chest wall.
• Step 2: Hydrodissection Hydrodissection is performed as a safety measure to confirm the correct positioning of the needle. Saline is injected in front of the tip of the needle, creating a halo effect that aids in visualizing the needle's location within the fascial plane, ensuring that it is not inadvertently placed intramuscularly.
• Step 3: Needle Advancement Once the correct position is confirmed, the block needle is advanced into the interfascial plane. This step is crucial for ensuring that the local anesthetic will be delivered to the appropriate area for optimal pain relief.
• Step 4: Catheter Insertion Following the advancement of the needle, a catheter is inserted through the placement needle. The needle is then carefully removed, leaving the catheter in place to facilitate continuous infusion of the local anesthetic.
• Step 5: Securing the Catheter The catheter is secured to prevent displacement, ensuring that the local anesthetic can be continuously infused into the fascial plane on one side of the thorax.

3. Post-Procedure

After the thoracic fascial plane block is performed, patients are monitored for any immediate complications or adverse effects. The continuous infusion of local anesthetic is initiated to provide ongoing pain relief. Patients may experience varying degrees of numbness and reduced sensation in the targeted area, which is expected. It is important to assess the effectiveness of the block in managing pain and to adjust the infusion rate as necessary. Follow-up care may include monitoring for signs of infection at the catheter insertion site and ensuring that the catheter remains patent for the duration of the infusion. Patients should be educated on the signs of potential complications and the importance of reporting any unusual symptoms to their healthcare provider.