Thoracic wall fascial plane blocks: a narrative review for breast, thoracic, and cardiac surgery

Abstract

Thoracic wall surgery is frequently associated with severe and multifactorial postoperative pain, including somatic, visceral, and neuropathic components. Inadequate pain control can impair respiratory function, delay mobilization, prolong hospitalization, and contribute to the development of chronic postsurgical pain. Traditional techniques, such as thoracic epidural and paravertebral blocks, have shown efficacy; however, their complexity and risk profiles limit their widespread use. In recent years, ultrasound-guided fascial plane blocks have gained prominence because of their favorable safety profile, ease of use, and suitability for incorporation into multimodal analgesia strategies. This narrative review provides an overview of the anatomical rationale, mechanisms of action, and clinical applications of fascial plane blocks of the thoracic wall, namely the interpectoral and pectoserratus, serratus anterior, erector spinae, and parasternal intercostal plane blocks. These techniques have demonstrated promising results in breast, thoracic, and cardiac surgeries, with analgesic outcomes comparable to those of conventional methods in many studies. Although evidence suggests a favorable safety profile and potential for opioid-sparing effects, further high-quality research is required to confirm their efficacy across diverse patient populations and surgical contexts. As clinical experience and data continue to accumulate, thoracic wall fascial plane blocks are emerging as important components of modern perioperative pain management strategies.