{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:28:22Z","timestamp":1792787302051,"version":"4.5.0"},"reference-count":11,"publisher":"BMJ","issue":"10","funder":[{"name":"Mayo Clinic Department of Anesthesiology and Perioperative Medicine","id":[{"id":"https:\/\/ror.org\/02qp3tb03","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2025,3,17]]},"published-print":{"date-parts":[[2026,10]]},"abstract":"\n Introduction<\/jats:title>\n Superficial parasternal intercostal plane blocks have grown in clinical use for cardiac surgery as a targeted fascial plane block for median sternotomy. Despite this, there remains no consensus on technique for optimal parasternal spread of injectate. The primary objective of this cadaveric study was to evaluate parasternal spread of injectate of single versus two-level superficial parasternal intercostal plane injections with the needle tip positioned on the anterior surface of the costal cartilage.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We performed 10 single-level injections at T4 and 10 two-level injections at T3 and T5 on alternating sides in 10 fresh frozen cadavers. All injections were ultrasound guided with a parasagittal ultrasound probe orientation and an in-plane needle orientation. Anatomic dissections were performed immediately following injections.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Parasternal spread of injectate was greater with two-level injections at T3 and T5 costal cartilages than with single-level injections at the T4 costal cartilage, with two-level injections consistently spreading to the T2\u2013T5 intercostal spaces. Median (Q1, Q3) intercostal space spread for single-level injections was 2.0 (2.0\u20132.5). Median (Q1, Q3) intercostal space spread for two-level injections was 4.0 (4.0\u20134.375).<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Two-level injections with the needle tip located on the anterior surface of the costal cartilage resulted in improved parasternal spread compared with single-level injections.<\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/rapm-2025-106488","type":"journal-article","created":{"date-parts":[[2025,4,7]],"date-time":"2025-04-07T13:25:33Z","timestamp":1744032333000},"page":"1133-1136","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Single versus two-level superficial parasternal intercostal plane block: cadaveric evaluation of injectate spread with needle tip position on anterior surface of costal cartilage"],"prefix":"10.1136","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5075-0892","authenticated-orcid":false,"given":"Jon","family":"Christensen","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Ritter","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Douglas","sequence":"additional","affiliation":[{"name":"Anesthesiology and Acute Pain Medicine, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Punnose","family":"Kattil","sequence":"additional","affiliation":[{"name":"Department of Clinical Anatomy, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nirusha","family":"Lachman","sequence":"additional","affiliation":[{"name":"Department of Clinical Anatomy, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William J","family":"Mauermann","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,4,7]]},"reference":[{"key":"2026100502151102000_51.10.1133.1","doi-asserted-by":"publisher","DOI":"10.1097\/AJP.0000000000001022"},{"key":"2026100502151102000_51.10.1133.2","doi-asserted-by":"publisher","DOI":"10.1053\/j.jvca.2021.09.041"},{"key":"2026100502151102000_51.10.1133.3","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1053\/j.jvca.2020.07.058","article-title":"Ultrasound-Guided Pecto-Intercostal Fascial Block for Postoperative Pain Management in Cardiac Surgery: A Prospective, Randomized, Placebo-Controlled Trial","volume":"35","author":"Khera","year":"2021","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"2026100502151102000_51.10.1133.4","article-title":"Superficial Parasternal Intercostal Plane Blocks (SPIB) With Buprenorphine, Magnesium, and Bupivacaine for Management of Pain in Coronary Artery Bypass Grafting","volume":"14","author":"Krishnan","year":"2022","journal-title":"Cureus"},{"key":"2026100502151102000_51.10.1133.5","doi-asserted-by":"crossref","DOI":"10.1186\/s12871-024-02432-w","article-title":"Comparison of the effects of transversus thoracic muscle plane block and pecto-intercostal fascial block on postoperative opioid consumption in patients undergoing open cardiac surgery: a prospective randomized study","volume":"24","author":"Mansour","year":"2024","journal-title":"BMC Anesthesiol"},{"key":"2026100502151102000_51.10.1133.6","doi-asserted-by":"crossref","DOI":"10.1186\/s12871-021-01391-w","article-title":"Effects of bilateral Pecto-intercostal Fascial Block for perioperative pain management in patients undergoing open cardiac surgery: a prospective randomized study","volume":"21","author":"Zhang","year":"2021","journal-title":"BMC Anesthesiol"},{"key":"2026100502151102000_51.10.1133.7","doi-asserted-by":"publisher","DOI":"10.1177\/1090820X13515902"},{"key":"2026100502151102000_51.10.1133.8","doi-asserted-by":"crossref","first-page":"1153","DOI":"10.1016\/j.bja.2023.08.014","article-title":"Superficial versus deep parasternal intercostal plane blocks: cadaveric evaluation of injectate spread","volume":"132","author":"Douglas","year":"2024","journal-title":"Br J Anaesth"},{"key":"2026100502151102000_51.10.1133.9","doi-asserted-by":"publisher","DOI":"10.1136\/rapm-2024-106012"},{"key":"2026100502151102000_51.10.1133.10","doi-asserted-by":"publisher","DOI":"10.1136\/rapm-2024-105818"},{"key":"2026100502151102000_51.10.1133.11","doi-asserted-by":"crossref","DOI":"10.1155\/2019\/6212039","article-title":"Anatomical Variations of the Pectoralis Major Muscle: Notes on Their Impact on Pectoral Nerve Innervation Patterns and Discussion on Their Clinical Relevance","volume":"2019","author":"Ha\u0142adaj","year":"2019","journal-title":"Biomed Res Int"}],"container-title":["Regional Anesthesia & Pain Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/rapm-2025-106488","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T09:15:51Z","timestamp":1791191751000},"score":1,"resource":{"primary":{"URL":"https:\/\/rapm.bmj.com\/lookup\/doi\/10.1136\/rapm-2025-106488"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,7]]},"references-count":11,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,10,5]]},"published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1136\/rapm-2025-106488"],"URL":"https:\/\/doi.org\/10.1136\/rapm-2025-106488","relation":{},"ISSN":["1098-7339","1532-8651"],"issn-type":[{"value":"1098-7339","type":"print"},{"value":"1532-8651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,7]]}}}