EXPAREL can be used in abdominal and pectoral field blocks

In breast surgery, field block infiltration or fascial plane infiltration can be an effective technique in a multimodal analgesic strategy1,2

  • A PECS (ultrasound-guided medial and lateral pectoralis nerve) block is a less invasive technique for providing analgesia after breast surgery compared with standard approaches such as thoracic epidural, paravertebral, intercostal nerve, and interpleural blocks2,3
  • In PECS I and PECS II field infiltration, ultrasound guidance can be used to identify the appropriate fascial plane(s) and to deposit local anesthetic to provide regional analgesia2
    • PECS blocks are applied in the pectoral and axillary regions, with the muscles in both regions innervated by the brachial plexus3
  • A PECS block can be administered by the anesthesiologist or surgeon; direct injection during open surgery is also possible2
  • These techniques provide effective analgesia after breast surgery and, unlike thoracic paravertebral and epidural blocks, are not associated with sympathetic block2

Areas covered by a PECS I or PECS II block

External anterior view of areas covered by PECS I and PECS II nerve blocks

  • PECS I block3 Devised to anesthetize the medial and lateral pectoral nerves, which innervate the pectoralis muscles
  • PECS II block3 Extends the block to provide blockade of the upper intercostal nerves

Consider the neuroanatomy to target the appropriate nerves for a PECS block

Interior view of nerves to target with a PECS block

PECS I block2

  • The lateral and medial pectoral nerves lie in the fascial plane between the pectoralis major and minor muscles

PECS II block2

  • Spinal nerves T2-T4 lie in the fascial plane between the pectoralis minor and serratus anterior muscles

Internal sagittal view of where to inject local anesthetic

  • PECS I block2 Injection between pectoralis major and minor muscles
  • PECS II block2 Injection between the pectoralis muscles and a second injection between the serratus anterior and pectoralis minor muscles

Learn how to perform PECS blocks with EXPAREL by procedure type: