Surgical excision of the breast giant fibroadenoma under regional anesthesia by Pecs II and internal intercostal plane block: a case report and brief technical description: a case report

Abstract

A 22-years-old female patient at 171 cm and 67 kg visited the Department of Breast Surgery of the hospital with a mass accompanied with pain on the left side breast as chief complaints. Since physical examination revealed a suspected huge mass, breast surgeon decided to perform surgical excision and requested anesthesia to our department. Surgery of breast tumor is often under local anesthesia. However, in case of big size tumor, surgery is usually performed under general anesthesia. The patient feared general anesthesia. Unlike abdominal surgery, there is no need to control visceral pain for breast and anterior thoracic wall surgery. Therefore, we decided to perform resection under regional anesthesia. Herein, we report a successful anesthetic and pain management of the patient undergoing excision of a huge breast fibroadenoma under regional anesthesia using Pecs II and internal intercostal plane block.

Efficacy of Pectoral Nerve Block Type II for Breast-Conserving Surgery and Sentinel Lymph Node Biopsy: A Prospective Randomized Controlled Study

“…Therefore, they cannot block anterior cutaneous branches of the second to sixth TICNs and branches of the supraclavicular nerves. Although several recent studies have also mentioned these limitations of the PECS II block [ 15 , 19 , 20 ], those studies, in contrast to ours, did not demonstrate these limitations.…”

Newer regional analgesia interventions (fascial plane blocks) for breast surgeries: Review of literature

“…Table 2 summarises the articles included, technique of fascial plane block used and the main outcome related to it. [ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 ]…”

“…Majority of the authors advocate giving a combination of blocks to cover analgesia over whole of the chest wall, axilla and shoulder. [ 14 15 16 17 18 19 20 21 22 23 24 ] The majority of evidence in the application of interfascial plane blocks for breast surgeries exists in the form of case reports or case series. In the reported case reports, these blocks were used with general anaesthesia and were useful in reducing intra- and post-operative analgesic requirements.…”

“…In the reported case reports, these blocks were used with general anaesthesia and were useful in reducing intra- and post-operative analgesic requirements. [ 14 16 21 ] Combination of blocks was used as per the area of the surgery or anaesthesiologists preference and no standard guidelines exist on blocks to be used for specific surgeries. In general, pectoralis nerve block 1 (PECS1) and serratus anterior plane (SAP) block when used alone lead to sparing of axilla, medial and posterior part of chest, and hence may be combined with PECS2 to cover the axilla; and pectoro-intercostal fascial block (PIFB) to cover medial part of the breast.…”

Pectoral nerve II block, transversus thoracic muscle plane block, and dexmedetomidine for breast surgery in a patient with achondroplasia: a case report

“…Thereafter, they reported bilateral Pecs II and TTP blocks without general anesthesia for bilateral breast resection in a patient with severe obstructive pulmonary disease [12]. Kim et al have reported Pecs II block and internal intercostal plane block without general anesthesia for a huge breast fibroadenoma resection in a patient with fear for general anesthesia [13]. Hong et al have reported modified Pecs II block (below the serratus muscle as the second injection) and pectointercostal fascial block without general anesthesia for partial resection of recurrent breast cancer in a parturient [14].…”