Thoracic interfascial nerve block for breast surgery in a pregnant woman: a case report

Abstract

Regional anesthesia for non-obstetric surgery in parturients is a method to decrease patient and fetal risk during general anesthesia. Thoracic interfascial nerve block can be used as an analgesic technique for surgical procedures of the thorax. The Pecs II block is an interfascial block that targets not only the medial and lateral pectoral nerves, but also the lateral cutaneous branch of the intercostal nerve. Pecto-intercostal fascial block (PIFB) targets the anterior cutaneous branch of the intercostal nerve. The authors successfully performed a modified Pecs II block and PIFB without complications in a parturient who refused general anesthesia for breast surgery.

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 ]…”

“…Interfascial plane blocks described for analgesia of chest have been found to be covering these dermatomes and thus appear to be effective for perioperative analgesia following breast surgeries [ Table 1 ]. [ 8 9 10 11 12 13 14 ] Since the description of these newer and safer interfascial plane blocks, various authors have studied their use in breast surgeries. At present, it is difficult to determine the superiority of one technique over the other in view of insufficient data.…”

“…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

“…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]. Compared with these reports, our case was challenging in terms of determining the dose of local anesthetics because the body weight of the patient was only 30 kg.…”