Pectoral nerve block (Pecs block) with sedation for breast conserving surgery without general anesthesia

Abstract

Most regional anesthesia in breast surgeries is performed as postoperative pain management under general anesthesia, and not as the primary anesthesia. Regional anesthesia has very few cardiovascular or pulmonary side-effects, as compared with general anesthesia. Pectoral nerve block is a relatively new technique, with fewer complications than other regional anesthesia. We performed Pecs I and Pec II block simultaneously as primary anesthesia under moderate sedation with dexmedetomidine for breast conserving surgery in a 49-year-old female patient with invasive ductal carcinoma. Block was uneventful and showed no complications. Thus, Pecs block with sedation could be an alternative to general anesthesia for breast surgeries.

Pectoral nerves blocks (PECS) and sedation: A way to avoid general anesthesia in breast surgery – A single institution early experience

“…Since the introduction of PECS II block, several randomized trials have shown its efficacy in reducing postoperative pain and opioid consumption in patients undergoing mastectomy . However, in all these studies RA techniques were always used in association with GA, and there are only a few anecdotal cases reporting the use of PECS blocks as the primary anesthesia in the literature …”

“…Murata et al firstly reported two cases of breast surgery (a simple mastectomy and a lumpectomy) without axillary surgery in two women aged 91 and 94, respectively. Subsequently, in 2017, Moon et al reported a 49‐year‐old woman undergoing WLE + ANC treated successfully with PECS blocks and sedation. Finally, Galán Gutiérrez et al have recently reported two patients with multiple comorbidities, including severe respiratory disease, who received Mx + axillary surgery with a similar anesthetic technique.…”

Narcotics and breast surgery: a review of current literature

“…In addition to non-narcotic multi-modals, the use of regional anesthesia to control pain in the perioperative period is also being explored. It is known that injuries to muscle and nerves during breast surgery in the acute postoperative period and more severe acute postoperative pain are risk factors for chronic pain [13,14] . A randomized study by Karmakar et al [15] assessed the development of chronic pain after modified radical mastectomy in patients who received thoracic paravertebral block (TPVB) vs. placebo and found that patients who received the TPVB exhibited fewer symptoms and signs of chronic pain [15] .…”

“…In a randomized controlled trial by Wahba and Kamal, they compared traditional paravertebral block to pectoral nerve block and found that, among patients undergoing modified radical mastectomy, those who received pectoral block had less morphine consumption and lower intensity of pain in the first 12 h compared to patients who received paravertebral block [22] . Moon et al [13] presented a case in which a pectoral nerve block was used in a patient who underwent monitored anesthesia care, thereby avoiding complications related to general anesthesia. The advantages of the pectoral block include no risk of sympathectomy and less restrictions on use of anticoagulants with studies showing a reduced postoperative morphine consumption in the first 24 h and lower pain scores in the first 12 h in the pectoral block group compared to TPVB in modified radical mastectomy.…”

“…The advantages of the pectoral block include no risk of sympathectomy and less restrictions on use of anticoagulants with studies showing a reduced postoperative morphine consumption in the first 24 h and lower pain scores in the first 12 h in the pectoral block group compared to TPVB in modified radical mastectomy. They found the pectoral block to be a safe and useful alternative for outpatient surgery as well as for shortening hospital stay and improving bed rotation rate [13] . Bashandy and Abbas similarly found that the combination of a pectoral nerve block and general anesthesia was superior to general anesthesia alone while FitzGerald et al [16] agreed with the use of pectoral block as suitable for day-case procedures for appropriate anesthetic [16,20] .…”