Ann Surg Treat Res.  2017 Sep;93(3):166-169. 10.4174/astr.2017.93.3.166.

Pectoral nerve block (Pecs block) with sedation for breast conserving surgery without general anesthesia

• Moon EJ
• Kim SB
• Chung JY
• Song JY
• Yi JW

• KMID: 2398964
• DOI: http://doi.org/10.4174/astr.2017.93.3.166

Abstract

Most regional anesthesia in breast surgeries is performed as postoperative pain management under general anesthesia, and not as the primary anesthesia. Regional anesthesia has very few cardiovascular or pulmonary side-effects, as compared with general anesthesia. Pectoral nerve block is a relatively new technique, with fewer complications than other regional anesthesia. We performed Pecs I and Pec II block simultaneously as primary anesthesia under moderate sedation with dexmedetomidine for breast conserving surgery in a 49-year-old female patient with invasive ductal carcinoma. Block was uneventful and showed no complications. Thus, Pecs block with sedation could be an alternative to general anesthesia for breast surgeries.

Keyword

Breast conserving surgery; Nerve block; Pectoral nerves

MeSH Terms

Anesthesia
Anesthesia, Conduction
Anesthesia, General*
Breast*
Carcinoma, Ductal
Conscious Sedation
Dexmedetomidine
Female
Humans
Mastectomy, Segmental*
Middle Aged
Nerve Block
Pain, Postoperative
Dexmedetomidine

Figure

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  Fig. 1 (A) On ultrasound imaging, 1.7 × 2.6-cm irregular ill-defined hypoechoic nodule with microcalcifications is observed. Microcalcification is observed around the mass. (B) On left mammography, about 8-cm segmental fine pleomorphic microcalcifications is observed.

• 

  Fig. 2 (A) The needle was advanced to the tissue plane between the pectoralis major muscle and pectoralis minor muscle (m.) (white arrow) for Pecs I block and to the tissue plane between the pectoralis minor muscle and serratus anterior muscle (black arrow) at the level of the third rib for Pecs II block. (B) Graphics representing probe position and the anatomical structures of ultrasound image. White arrow points at the pectoral branch of the acromiothoracic artery.

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