PEC 1 & 2 Blocks, Serratus Anterior Block

I’ve been hearing more and more about PEC 2 block for mastectomy.  What’s wonderful about this block is that it seems that the risk of pneumothorax is lower than for a paravertebral block.

Egyptian Journal of Anaesthesia; April 2014. Thoracic Paravertebral Block vs. Pectoral Nerve Block for Analgesia after Breast Surgery

SlideShare powerpoint: PEC 1 & 2 and Serratus Anterior Blocks

Current Anesthesiol Rep, 2015. Regional Anesthesia for Breast Surgery: Techniques and Benefits.

Rev Esp Anesthesia Reanim; 2012: Ultrasound Description of PECS 2 (modified PECS 1): A Novel Approach to Breast Surgery

Poster Summary of PECS 2

TAP, PEC 1, & PEC 2 Blocks PPT

Anaesthesia, 2013. Serratus Plane Block: A Novel Ultrasound-Guided Thoracic Wall Nerve Block.

NYSORA 2014: Update on truncal blocks

Summary:

• U/S guidance: probe position similar to infraclavicular block. Find 3rd, 4th rib.
• Pt position: Head away from side of block. Ipsilateral arm abducted.
• PEC 2: Inject 20 ml 0.25% bupi between pec minor and serratus.
• PEC 1: Inject 10 ml 0.25% bupi between pec major and pec minor.
• Serratus: 5th rib, mid-axillary line. Inject 30 ml 0.125% bupi along top (superficial) and bottom (deep) of serratus muscle (which is just deep to the latissmus dorsi).

YouTube: PECS 1&2 Block

YouTube: Serratus plane block

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Update: Oct 24, 2018

PECs blocks in Cardiac Surgery

http://www.annals.in/article.asp?issn=0971-9784;year=2018;volume=21;issue=3;spage=333;epage=338;aulast=Kumar

http://www.apicareonline.com/ultrasoundguidedblocksforsurgeries-proceduresinvolvingchestwall-pecs-12andserratusplaneblock/

https://www.ncbi.nlm.nih.gov/m/pubmed/29016551/

 

Paravertebral Block: basics and cancer recurrence

 

From J Anaesthesiol Clin Pharmacol. 2011 Jan-Mar; 27(1): 5–11.

Why do paravertebral blocks?

• Journal of Anesthesiology Clinical Pharmacology – Paravertebral Blocks

Paravertebral blocks and decreased cancer recurrence

• BJA 2010 – Efficacy and Safety of Paravertebral Blocks in Breast Surgery: a meta-analysis of randomized clinical trials
• BJA 2010 – Effect of Anesthetic Technique and Other Perioperative Factors on Cancer Reccurence
• Anesthesiology 2006 – Can anesthetic technique for primary breast cancer surgery affect recurrence or metastasis?
• BJA 2012 – Can anesthetic and analgesic techniques affect cancer recurrence and risk?
• ASA: Paravertebral Block Ups Breast Cancer Surgery Outcomes

Paravertebral block techniques

From NYSORA

YouTube paravertebral block from LSORA

• Anesthesiology News – Paravertebral Blocks: The Evolution of a Standard of Care
• YouTube Ultrasound-Guided Paravertebral Block
• NYSORA – Paravertebral Block: Landmark Technique
• Paravertebral Block Landmark Technique
• NYSORA – Paravetebral Block: Ultrasound-Guided Technique

But wait… what about the potential side effects/adverse events from a paravertebral block?

Why not do a TIVA with propofol and dexmetetomedine and local anesthesia via surgeon?  Where’s that study to compare?

** Update **  July 20, 2016 –> What about the PEC 1&2 Blocks as well as Serratus block?

Prolonging blockade with adjuvants:

• IOSR J of Dental and Medical Sci; Dec 2015. Comparative study of bupiv with dexamethasone and bupi with clonidine through single space PVB for post op analgesia in thoracic and abdominal surgeries.
• 0.125% Bupiv + clonidine (1mcg/kg) vs 0.125% bupiv + dexamethasone (4mg): greater duration of analgesia in the dexamethasone group.