Modified pectoral nerve block for unilateral mastectomy

Abstract

General anesthesia combined with opioid therapy is the most common anesthetic technique used for patients undergoing breast cancer surgery; however, inhaled anesthetics and opioids are notorious offenders of a fragile immune system and create hemodynamic compromise. By reducing the requirements of general anesthetics and opioids, the risks associated with each are greatly reduced. Regional anesthesia is a safe alternative or adjunct to general anesthesia, as it effectively reduces perioperative opioid consumption and limits the amount of anesthesia required intraoperatively. The modified pectoral nerve block (Pecs II block) is a regional technique that provides extensive sensory and motor blockade to the nerves supplying the anterior thoracic wall. This novel approach supersedes conventional regional techniques to anesthetize the thoracic wall for procedures involving the breasts and axillary lymph nodes. Compared to other techniques, the Pecs II block is anatomically less challenging, associated with fewer complications, and has a higher rate of success. For patients undergoing breast cancer surgery, the Pecs II block combined with conscious sedation greatly reduces the risks associated with general anesthesia and offers long-terms benefits.