Keywords: Tietze's Syndrome, USG, Chest pain, VAS

Aim:

Tietze syndrome can impose a clinically meaningful burden through persistent anterior chest wall pain, tenderness, and activity limitation, thereby impairing daily functioning and quality of life. Interventional management of refractory Tietze syndrome in the literature has largely focused on local costochondral injections, most commonly combining corticosteroid with local anesthetic, while ultrasound guidance is increasingly used to enhance targeting and procedural safety. We aim to evaluated the mid-term analgesic impact and safety of ultrasound-guided (USG) three-level intercostal nerve blockade performed as a targeted regional analgesic strategy.

Method:

We conducted a retrospective, single-center cohort study of patients treated for clinically diagnosed Tietze syndrome with USG-guided intercostal blockade. The block was standardized to the maximally painful intercostal level and the adjacent cranial and caudal levels (painful level ±1). Under real-time ultrasound guidance, a bupivacaine–lidocaine local anesthetic mixture was injected at 3 mL per level (total 9 mL). Pain intensity was quantified using the visual analog scale (VAS) immediately before intervention and at the 3rd-month follow-up. Continuous variables are reported as mean±SD.

Results:

Twenty-three patients were included. Mean pre-procedural VAS was 7.87±1.42 and decreased to 2.52±2.69 at 3 months, yielding an absolute mean reduction of 5.35 VAS units. No procedure-related complications or adverse events were recorded.

Conclusions:

In this retrospective series, USG-guided three-level intercostal blockade using a bupivacaine–lidocaine mixture was associated with substantial pain reduction sustained to 3 months and an excellent safety profile. These data support the feasibility of a focused ultrasound-guided regional approach for symptomatic Tietze syndrome; prospective controlled studies with standardized diagnostic criteria and functional endpoints are needed to define comparative effectiveness and durability.