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A CASE REPORT OF THE USE OF ULTRASOUND-GUIDED PECTORAL NERVE I AND II BLOCKS FOR AWAKE BREAST CANCER SURGERY
ESRA Academy. Kurzatkowski K. Sep 8, 2016; 138314; 0142 Topic: Breast surgery
Dr. Krzysztof Kurzatkowski
Dr. Krzysztof Kurzatkowski

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Abstract
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Background and Aims:

Pectoral Nerve Blocks (PECS) offer a simple regional technique to provide effective analgesia for breast procedures. PECS blocks have been mainly described as an addition to general anaesthesia. We describe the case of using an ultrasound-guided PECS 1 and 2 for awake breast surgery.

Methods:

An 81 year old ASA 2 patient, presented for day-case wide local excision for breast carcinoma. She refused to have surgery unless it could be done awake. PECS blocks were performed using an in-plane ultrasound approach. An 18 gauge, 90 mm SonoTAP Tuohy was positioned between serratus anterior and pectorals minor. Following the location confirmation with 0.9% saline “seeker solution,' a satisfactory spread of 20mls of 1% Prilocaine/0.5% L-bupivacaine (50:50 mix) was observed. The needle was subsequently withdrawn under ultrasound guidance and further 10ml of the same mix was administered between pectorals minor and pectorals major.

Results:

Surgery commenced 33 minutes after the PECS blocks and lasted for 58minutes, on minimal propofol sedation (0.3mcg/ml). The patient reported no pain during the procedure, maintaining verbal communication throughout. She went home 4 hours after completion of the surgery, receiving 250mg of paracetamol in recovery.

Conclusions:

PECS blocks are able to provide excellent surgical anaesthesia as well as analgesia. This could give a surgical option for patients either unwilling or unfit for GA, particularly important in cancer patients. Additionally they increase the available options for facilitation of early discharge by avoidance of opiates and their side effects, increasing the potential for day case surgery.

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