In breast surgery, field block infiltration or fascial plane infiltration can be an effective technique in a multimodal analgesia 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 blocks.2,3
PECS blocks are applied in the pectoral and axillary regions, with the muscles in both regions innervated by the brachial plexus.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 analgesia.2
These techniques provide effective analgesia after breast surgery and, unlike thoracic paravertebral and epidural blocks, are not associated with sympathetic blocks.2
- PECS blocks with EXPAREL
PECS blocks can be administered by the anesthesiologist or surgeon;
direct injection during open surgery is also possible2
Areas covered by a PECS I or PECS II block
External anterior view of areas covered by PECS I and PECS II block
PECS I block3Devised to anesthetize the medial and lateral pectoral nerves, which innervate the pectoralis muscles
PECS II block3Extends 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 block2The lateral and medial pectoral nerves lie in the fascial plane between the pectoralis major and minor muscles
PECS II block2Spinal 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 block2Injection between pectoralis major and minor muscles
PECS II block2Injection between the pectoralis muscles and a second injection between the serratus anterior and pectoralis minor muscles
