307: Clinical Efficacy of Serratus Posterior Superior Intercostal Plane Block in Myofascial Pain Syndrome

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic primary musculoskeletal pain, Pharmacological treatments, Treatment/management

Background and Aims: Myofascial pain syndrome (MPS) of the cervicothoracic region is a common cause of chronic neck and upper back pain that often shows limited response to conservative therapies. The recently described serratus posterior superior intercostal plane block (SPSIPB) targets the fascial plane between the serratus posterior superior and intercostal muscles and may provide effective regional analgesia. However, its long-term clinical efficacy in MPS has not been systematically evaluated. This study aimed to investigate the effectiveness and safety of ultrasound-guided SPSIPB in patients with unilateral cervicothoracic MPS.

Methods: This retrospective single-center study analyzed medical records of 30 patients with unilateral cervicothoracic MPS who underwent ultrasound-guided SPSIPB between June 2024 and May 2025. Pain intensity (Numerical Rating Scale, NRS), disability (Neck Disability Index, NDI), and health-related quality of life (EQ-5D-5L) were assessed at baseline and at 4 weeks, 12 weeks, and 6 months post-procedure. Within-group changes were analyzed using the Friedman and Wilcoxon signed-rank tests with Bonferroni correction. Logistic regression was used to identify predictors of treatment success (≥50% reduction in NRS).

Results: Median baseline NRS was 8.0 (IQR: 7.0–9.0), which decreased significantly to 3.0 (2.0–4.0) at 6 months (p < 0.001). Significant improvements were also observed in NDI (median 28.0 → 15.0, p < 0.001) and EQ-5D scores (median 9.0 → 8.0, p < 0.001). The clinical success rate was 76.7% at 4 weeks, 70.0% at 12 weeks, and 66.7% at 6 months. No major adverse events were reported. Logistic regression revealed no significant predictors of block success, although symptom duration and baseline pain intensity showed positive, non-significant trends.

Conclusions: Ultrasound-guided SPSIPB appears to be a safe and effective treatment for unilateral cervicothoracic myofascial pain syndrome, providing rapid and sustained improvements in pain, disability, and quality of life for up to six months. These findings support SPSIPB as a promising interfascial approach for chronic myofascial pain management.

References: 1. Simons DG: Clinical and Etiological Update of Myofascial Pain from Trigger Points. Journal of Musculoskeletal Pain 1996, 4(1-2):93-122.
2. Steen JP, Jaiswal KS, Kumbhare D: Myofascial Pain Syndrome: An Update on Clinical Characteristics, Etiopathogenesis, Diagnosis, and Treatment. Muscle Nerve 2025, 71(5):889-910.
3. Cao QW, Peng BG, Wang L, Huang YQ, Jia DL, Jiang H, Lv Y, Liu XG, Liu RG, Li Y et al: Expert consensus on the diagnosis and treatment of myofascial pain syndrome. World J Clin Cases 2021, 9(9):2077-2089.
4. Galasso A, Urits I, An D, Nguyen D, Borchart M, Yazdi C, Manchikanti L, Kaye RJ, Kaye AD, Mancuso KF et al: A Comprehensive Review of the Treatment and Management of Myofascial Pain Syndrome. Current Pain and Headache Reports 2020, 24(8):43.
5. Wu WT, Chang KV, Ricci V, Özçakar L: Ultrasound imaging and guidance in the management of myofascial pain syndrome: a narrative review. J Yeungnam Med Sci 2024, 41(3):179-187.
6. Marrone F, Pullano C, De Cassai A, Fusco P: Ultrasound-guided fascial plane blocks in chronic pain: a narrative review. J Anesth Analg Crit Care 2024, 4(1):71.
7. Ricci V, Mezian K, Chang KV, Tarantino D, Güvener O, Gervasoni F, Naňka O, Özçakar L: Ultrasound Imaging and Guidance for Cervical Myofascial Pain: A Narrative Review. Int J Environ Res Public Health 2023, 20(5).
8. Stecco A, Gesi M, Stecco C, Stern R: Fascial components of the myofascial pain syndrome. Current pain and headache reports 2013, 17:1-10.
9. Fede C, Petrelli L, Guidolin D, Porzionato A, Pirri C, Fan C, De Caro R, Stecco C: Evidence of a new hidden neural network into deep fasciae. Scientific Reports 2021, 11(1):12623.
10. Stecco C, Pirri C, Fede C, Fan C, Giordani F, Stecco L, Foti C, De Caro R: Dermatome and fasciatome. Clinical Anatomy 2019, 32(7):896-902.
11. Tulgar S, Ciftci B, Ahiskalioglu A, Bilal B, Sakul BU, Korkmaz AO, Bozkurt NN, De Cassai A, Torres AJ, Elsharkawy H et al: Serratus Posterior Superior Intercostal Plane Block: A Technical Report on the Description of a Novel Periparavertebral Block for Thoracic Pain. Cureus 2023, 15(2):e34582.
12. Köksal BG, Baytar Ç, Bayraktar E, Balbaloğlu H: Effects of serratus posterior superior intercostal plane block on postoperative analgesia in patients undergoing breast cancer surgery: a randomized controlled trial. BMC Anesthesiol 2025, 25(1):209.
13. Kültüroğlu G, Altınsoy S, Özgüner Y, Çataroğlu CK: Novel Serratus Posterior Superior Intercostal Plane Block Provided Satisfactory Analgesia after Breast Cancer Surgery: Two Case Reports. Turk J Anaesthesiol Reanim 2024, 52(1):33-35.
14. Bansal S, Bansal A, Joad AK, Choudhari SH, Gupta P: New kid on the block: Covering neck, shoulder, and chest wall postoperative pain! Indian J Anaesth 2024, 68(12):1101-1103.
15. Guven Kose S, Kose HC, Celikel F, Tulgar S, Akkaya OT: Ultrasound-guided rhomboid intercostal block versus erector spinae plane block for unilateral dorsal back myofascial pain syndrome: a prospective, randomized trial. Minerva Anestesiol 2023, 89(4):279-288.
16. Yürük D, Akkaya Ö T, Polat Ö E, Alptekin HA: Ultrasound-Guided Erector Spinae Plane Block and Trapezius Muscle Injection for Myofascial Pain Syndrome. J Ultrasound Med 2022, 41(1):185-191.
17. Ozyemisci Taskiran O, Albayrak H, Topaloglu M, Manici M, Ketenci A, Gurkan Y: Effect of Ultrasound-Guided Rhomboid Interfascial Plane Block on Pain Severity, Disability, and Quality of Life in Myofascial Pain Syndrome - A Case Series With One-Year Follow-Up. Pain Physician 2023, 26(7):E815-e822.
18. Köse SG, Köse HC, Tulgar S, Akkaya Ö T: Ultrasound-guided rhomboid intercostal block for myofascial pain syndrome: a prospective clinical study. Turk J Med Sci 2022, 52(5):1737-1743.
19. Vernon H, Mior S: The Neck Disability Index: a study of reliability and validity. J Manipulative Physiol Ther 1991, 14(7):409-415.
20. Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D, Bonsel G, Badia X: Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res 2011, 20(10):1727-1736.
21. Travell J, Rinzler SH, Herman MN: PAIN AND DISABILITY OF THE SHOULDER AND ARM: TREATMENT BY INTRAMUSCULAR INFILTRATION WITH PROCAINE HYDROCHLORIDE. JAMA 1942, 120:417-422.
22. Thompson J: Myofascial Pain and Dysfunction: The Trigger Point Manual, Vol 1: Upper Half of Body (2nd Ed.). Journal of Psychosomatic Research - J PSYCHOSOM RES 2001, 51:403-404.
23. Fourie LJ: The scapulocostal syndrome. S Afr Med J 1991, 79(12):721-724.
24. Peck D, Buxton DF, Nitz A: A comparison of spindle concentrations in large and small muscles acting in parallel combinations. J Morphol 1984, 180(3):243-252.
25. Voss H: [Tabulation of the absolute and relative muscular spindle numbers in human skeletal musculature]. Anat Anz 1971, 129(5):562-572.
26. Taketa Y, Irisawa Y, Fujitani T: Ultrasound guided serrates posterior superior muscle block relieves interscapular myofascial pain. J Clin Anesth 2018, 44:10-11.
27. McCarthy C, Harmon D: A technical report on ultrasound-guided scapulocostal syndrome injection. Irish Journal of Medical Science 2016, 185(3):669-672.
28. Sawada A, Yamakage M: Ultrasound-guided serratus posterior superior muscle block for myofascial pain syndrome in the cervicoscapular region: a report of three cases. JA Clin Rep 2025, 11(1):42.
29. Wu Z, Wang Y, Ye X, Chen Z, Zhou R, Ye Z, Huang J, Zhu Y, Chen G, Xu X: Myofascial Release for Chronic Low Back Pain: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2021, 8:697986.
30. Laimi K, Mäkilä A, Bärlund E, Katajapuu N, Oksanen A, Seikkula V, Karppinen J, Saltychev M: Effectiveness of myofascial release in treatment of chronic musculoskeletal pain: a systematic review. Clinical Rehabilitation 2018, 32(4):440-450.
31. Kanamoto H, Orita S, Inage K, Shiga Y, Abe K, Eguchi Y, Ohtori S: Effect of Ultrasound-Guided Hydrorelease of the Multifidus Muscle on Acute Low Back Pain. J Ultrasound Med 2021, 40(5):981-987.
32. Arıcı T, Köken İ: Results of ultrasound-guided interfascial block of the trapezius muscle for myofascial pain. Agri 2022, 34(3):187-192.
33. Tulgar S, Ahiskalioglu A, De Cassai A, Gurkan Y: Efficacy of bilateral erector spinae plane block in the management of pain: current insights. J Pain Res 2019, 12:2597-2613.
34. Vidal E, Giménez H, Forero M, Fajardo M: Erector spinae plane block: a cadaver study to determine its mechanism of action. Revista Española de Anestesiología y Reanimación (English Edition) 2018, 65(9):514-519.
35. Fusco P, Pascarella G, Stecco C, Blanco R, Forero M, Pawa A, Tulgar S, Strumia A, Remore LM, A DEC et al: Factors to consider for fascial plane blocks' success in acute and chronic pain management. Minerva Anestesiol 2024, 90(1-2):87-97.
36. Groizard Botella MJ, Buriticá Aguirre AM, Palumbo M, Matute Crespo M, Vilà Justribó FJ, Montero Matamala A: Predictive factors for the efficacy of myofascial infiltration in chronic cervicalgia: implications for technique indication criteria. Advancements in Health Research 2025, 2(1).
37. Huang YT, Lin SY, Neoh CA, Wang KY, Jean YH, Shi HY: Dry needling for myofascial pain: prognostic factors. J Altern Complement Med 2011, 17(8):755-762.

Presenting Author: Banu Tan
Submitting Author: Sefa Tan

Senior Author: Sefa Tan

IASP 2026 Global Year theme of Neuropathic Pain: No

• Banu Tan - Department of of Pain Medicine, Necmettin Erbakan University, Konya, Turkey
• Sema Tuncer Uzun - Department of of Pain Medicine, Necmettin Erbakan University, Konya, Turkey
• Ruhiye Reisli - Department of of Pain Medicine, Necmettin Erbakan University, Konya, Turkey