one, they help mitigate the increased risk of PONV and the significant
level of post-op pain associated with breast surgery — a level that typ-
ically requires narcotics to be part of the multimodal analgesia regi-
men.
Additionally, at least one study (osmag.net/NNoYn6) suggests that when
breast cancer surgery is performed with ultrasound-guided blocks,
tumor recurrence and metastases are substantially reduced. Why?
Investigators theorize that surgery causes tumor cells to be released
into surrounding healthy tissue and circulation, and that the risk of
recurrence likely depends on immune system capability. Regional
anesthesia and analgesia may help preserve immune function by
attenuating the surgical stress response and reducing the need for opi-
oids
Fortunately, anesthesia providers can master pectoral nerves
blocks, an easy and reliable superficial block.
• PECs I block. This technically simple block covers the median (C8, T1)
and lateral pectoral nerves (C5, 6, 7), which lie between the pectoralis
major (PM) and pectoralis minor (Pm) muscles. It's best suited for pace-
makers and port-a-caths and for majority coverage for insertion of
breast expanders and subpectoral prosthesis. It doesn't cover the axil-
lary area, however, and both expanders and prosthesis may result in
additional pain in this area.
• PECs II block. The PECs II block incorporates the injection and cover-
age of the PECs I, but also adds a second injection between the planes
of the pectoralis minor and the anterior serratus muscle. This second
injection covers the long thoracic nerve (the nerve to the serratus ante-
rior), thoracic intercostal nerves from T2 to T6 and the thoracodorsal
nerve (the nerve to the latissimus dorsi). This provides coverage of the
axillary area, which provides analgesia for surgeries such as sentinel
node biopsy, mastectomies and complete reconstructions.
Anesthesia Alert
AA
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