CPT® Code 64469

1. Indications

The thoracic fascial plane block is indicated for the management of post-operative pain following various types of chest surgeries. This procedure is particularly beneficial for patients who require effective pain control to enhance recovery and minimize the use of opioid analgesics. The specific indications include:

• Post-operative Pain Management This block is performed to alleviate pain after surgical interventions in the thoracic region, such as thoracotomy or other chest-related surgeries.
• Reduction of Opioid Use The procedure aims to decrease the need for opioid medications, thereby reducing the risk of opioid-related side effects and complications.

2. Procedure

The thoracic fascial plane block involves several key procedural steps to ensure accurate placement and effective pain relief. The steps are as follows:

• Step 1: Ultrasound Guidance The procedure begins with the application of continuous ultrasound guidance. A transducer is placed over the target area of the thorax, allowing the clinician to visualize the relevant anatomical structures and layers of the chest wall. This imaging is crucial for identifying the correct location for the block.
• Step 2: Hydrodissection To enhance safety and accuracy, hydrodissection is performed. This involves the injection of saline in front of the needle tip, creating a halo effect that helps visualize the needle's position within the fascial plane. This step is essential for confirming that the needle is not intramuscularly positioned.
• Step 3: Needle Advancement Once the correct position is confirmed, the block needle is advanced into the interfascial plane. At this point, a local anesthetic is injected on one side to initiate the block.
• Step 4: Catheter Insertion For continuous infusion, a placement needle is inserted, and hydrodissection is again utilized to ensure proper positioning. A catheter is then threaded through the placement needle, which is subsequently removed, leaving the catheter in place.
• Step 5: Local Anesthetic Infusion The catheter is secured, and a local anesthetic is infused into the fascial plane on one side. This infusion provides ongoing pain relief.

3. Post-Procedure

After the thoracic fascial plane block is performed, patients are monitored for any immediate complications or adverse reactions to the anesthetic. The expected recovery involves a reduction in post-operative pain, allowing for improved mobility and comfort. Continuous infusion of the local anesthetic may be adjusted based on the patient's pain levels and response to treatment. It is important for healthcare providers to educate patients about the signs of potential complications, such as infection or catheter displacement, and to provide instructions for follow-up care. The overall goal is to facilitate a smoother recovery process while minimizing the need for systemic opioids.