Ultrasound-guided parasternal Pecs block: a new and useful supplement to Pecs I and serratus anterior plane blocks

Ultrasound-guided parasternal Pecs block: a new and useful supplement to Pecs I and serratus anterior plane blocks

Published: 04 Feb 2016

© Anaesthesia Cases / 2016-0007 / ISSN 2396-8397

Authors

Dr Christian Kruse Hansen [1]
Dr Mette Dam [2]
Dr Troels Dirch Poulsen [3]
Dr Per-Arne Lönnqvist [4]
Dr Thomas Fichtner Bendtsen [5]
Dr Jens Børglum [3]
  • [1] Clinical Research Fellow, Department of Anaesthesiolgy, Copenhagen University Hospital - Roskilde, Roskilde / Copenhagen, Denmark
  • [2] Clinical Research Fellow, Department of Anaesthesia and Intensive Care Medicine, Copenhagen Universtity Hospital – Roskilde, Roskilde, Denmark
  • [3] Consultant, Department of Anaesthesia and Intensive Care Medicine, Copenhagen Universtity Hospital – Roskilde, Roskilde, Denmark
  • [4] Professor, Department of Pediatric Anaesthesia and Intensive Care, Astrid Lindgren Children’s Hospital/Karolinska University Hospital, Stockholm, Sweden
  • [5] Consultant, Department of Anaesthesia and Intensive Care Medicine, Aarhus University Hospital, Aarhus, Denmark

Summary

We describe the use of ultrasound-guided parasternal Pecs (pectoral nerves) block for pain relief following mastectomy and reconstructive breast surgery. This new ultrasound-guided parasternal Pecs block provides effective supplementary analgesia when the established block techniques (e.g. Pecs I and serratus anterior block) together with multimodal analgesics fail to ameliorate pain arising from the parasternal area supplied by the anterior cutaneous branches of the intercostal nerves T2-T6. In this report, the patient undergoing reconstructive breast surgery continued to complain of severe pain even after substantial systemic opioids had been administered postoperatively in the recovery area. When the patient was administered the established Pecs I and serratus anterior blocks the pain was initially reduced markedly, but recurred in the parasternal area. Following administration of an ultrasound-guided parasternal Pecs block, the pain disappeared and the patient was pain-free when discharged to the ward.

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