PNS GUIDED PEC L AND SAP BLOCK FOR POST OPERATIVE ANALGESIC EFFECTS IN PATIENTS UNDERGOING MODIFIED RADICAL MASTECTOMY

Dr Ritesh Roy, Dr Nihar Ranjan Tripathy

Abstract


Introduction: In the recent years, chest wall blocks have taken the postoperative analgesia to newer levels in the field of
anesthesia. Blanco et al. initially described the ultrasound (US) guided chest wall blocks that used local anesthetic (LA) deposition
under pectoralis major (PEC I), then under the pectoralis minor (PEC II) and later modified these pectoralis blocks to cover larger
areas of the thoracic wall by depositing LA under and/or above the serratus anterior (SA) muscle (SA plane block).
Paravertebral blocks and thoracic epidural blocks, the gold standard for post-operative analgesia for chest wall surgeries often
have a high incidence of complications. The pectoralis (PEC) blocks, first described by Blanco et al., have been proven to provide
adequate analgesia postoperatively for breast surgeries, wide pectoral dissections, upper chest injuries, pacemaker insertions,
and intercostal chest drains. To make this simple and useful analgesia technique easy to use in routine procedures, which is limited
by the availability of ultrasound machine and expert knowledge of the sonoanatomy of the area, we are describing the innovative
technique of PEC-I block and SAP block using peripheral nerve stimulator, which is easily available in most of the health care
institutions and hence accessible to most of the anesthetists.
Technique of block: Please refer the Article
Discussion: Almost always all kind of breast surgeries require adequate post-operative analgesia techniques, for better patient
satisfaction. Thoracic epidural analgesia, thoracic paravertebral blocks (TPVB), interpleural blocks and intercostal nerve blocks
have all been very effective for such surgeries but, are associated with several complications such as epidural hematomas , nerve
injuries, pneumothorax, and hypotension. Analgesia technique like TPVB is often unreliable with a single injection, and pectoral
nerves are still spared producing inadequate analgesia of the thoracic wall and needed other modes of analgesia as well in
addition to the block. The pectoralis block (PEC block) and serratus anterior plane (SAP) block, technique were described by Blanco
et al. in 2011 and 2013 using ultrasound and were easy, reliable, and associated with fewer complications. Peripheral nerve
stimulators for such easy and superficial blocks increase the routine utilization of these blocks in various chest wall procedues and
benefits wider range of population. We have described the use of PNS for PEC-I block associated with serratus anterior plane block
to achieve excellent analgesia of the chest wall.


Keywords


Chest wall blocks, pectoral blocks, serratus anterior plane, serratus anterior plane block, ultrasound, peripheral nerve stimulator, ultrasoundguided, peripheral nerve stimulator guided.

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References


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