Thesis (Ph.D.) - Cairo University - National Cancer Institute - Department of Anaesthesia and Pain Relief

Patients undergoing breast surgery require a multimodal postoperative pain treatment regimen that provides high quality analgesia with minimal side effects. The neural supply of the anatomical structures involved in breast surgery is not well understood when it comes to providing analgesia for perioperative pain relief. Paravertebral block became the gold standard techniques to achieve this goal, but not every anesthesiologist is comfortable performing these procedures. As an alternative for these techniques we designed pectoral nerve block.1. Thoracic wall blocks (PECS I, PECS II and Serratus plane block) are peripheral nerve block alternatives to paravertebral block for providing both surgical anesthesia and postoperative analgesia for breast surgery. The Pecs block is a recently described, easy and reliable superficial block that targets the lateral and median pectoral nerves at an interfascial plane between the pectoralis major and minor muscles. It can be used for different breast operations, Other potential indications are traumatic chest injuries, iatrogenic pectoral muscle dissections, pacemakers, Portacaths and chest drains.3. The modified PECS block produces excellent analgesia and can be used to provide a balanced anesthesia and as a rescue block in cases where the analgesia provided by the paravertebral or epidural was patchy or ineffective.2

Issued also as CD