Medial and Lateral Pectoral Nerve Block with Liposomal Bupivacaine for the Management of Postsurgical Pain after Submuscular Breast Augmentation

Abstract

Summary:This report describes an ultrasound-guided medial and lateral pectoralis nerve block using liposome bupivacaine, performed before the surgical incision, in a patient undergoing submuscular breast augmentation. The anatomic basis and technique are described. This procedure may be offered to patients undergoing submuscular insertion of a breast implant or tissue expander. Advancements in ultrasound guidance allow for more precise anatomic placement of local anesthetic agents. The injection technique used for this procedure resulted in complete relaxation of the pectoralis major, facilitating the surgical dissection and markedly diminishing postsurgical pain and muscle spasms.

Injection Volume and Anesthetic Effect in Serratus Plane Block

“…The number of affected dermatomes assessed by the cold test was significantly larger for the patients receiving 40 mL of 0.375% ropivacaine than for patients receiving 20 mL (P = 0.0001; median [interquartile range], 6 [5][6][7] vs 4 [3][4] dermatomes) (Fig. 1).…”

An Evidence-Based Review of the Efficacy of Perioperative Analgesic Techniques for Breast Cancer-Related Surgery

“…The subsequent year, a modified version of this approach named the Pecs II block was described for axillary dissections by aiming to increase the number of nerves affected to include the intercostobrachial, intercostal 3-6, and long thoracic nerves [147]. Variant approaches have been published [148,149], including the insertion of a catheter to allow a postoperative perineural local anesthetic infusion [150]. The technique has been described primarily for breast augmentation [148,149], with one retrospective series reporting decreased pain scores at 8 hours when a pectoralis block was added to a paravertebral block compared with historic controls with solely a paravertebral block [151].…”

“…Variant approaches have been published [148,149], including the insertion of a catheter to allow a postoperative perineural local anesthetic infusion [150]. The technique has been described primarily for breast augmentation [148,149], with one retrospective series reporting decreased pain scores at 8 hours when a pectoralis block was added to a paravertebral block compared with historic controls with solely a paravertebral block [151]. However, the only available RCT involves radical mastectomy procedures in which subjects were randomized to receive either a general anesthetic or a general anesthetic plus combined Pecs I and II blocks with 0.25% bupivacaine [152].…”

New aspects of controlled release systems for local anaesthetics: A review

“…Leiman et al [64] have reported the case of a 28 year old patient undergoing breast augmentation which was administered liposomal bupivacaine. Following and 532 mg DepoFoam in patients with total knee arthroplasty.…”

“…), they found beneficial effects in terms of patient satisfaction and pain management[64]. Stephen et al[65] compared the effects of liposomal bupivacaine HCl with those of bupivacaine.…”