ESRA Academy. Fusco P. Sep 9, 2016; 138407; 0251 Topic: Breast surgery
Dr. Pierfrancesco Fusco
Dr. Pierfrancesco Fusco

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Background and Aims:

Recent literature highlights how PECS block represents a valid alternative to general anesthesia in breast surgery, especially in high risk clinical settings.


87-year-old patient, ASA 3, undergoing radical mastectomy. During the preoperative evaluation were revealed several parameters highly predictive of difficult intubation: Mallampati test degree 4, interincisor distance less than 30 mm, mental-thyroidal distance equal to 60 mm, fixed neck in flexion, turbinate hypertrophy and subtotal obstruction of the right nasal cavity. In order to avoid GA and awake fibreoptic intubation, USG PECS II Block with 20 ml of 0,5% Levobupivacaine was performed. Furthermore, an ipsilateral parasternal injection of 8 ml of 0,375% Levobupivacaine under ultrasound guidance was performed close to the external intercostal membrane under the major pectoral muscle, in direction of 2nd and 4th rib, to provide a sensitive block of the parasternal anterior branches of intercostal nerves. Supplemental oxygen (3 Lt/min) was administered by nasal dispenser. HR, MAP, SaO2%, ETCo2 were monitored; equipment for management of difficult airway was available.


A good anesthetic plane was ensured with PECS II Block, immediate recovery of vital functions and an excellent and long-lasting postoperative analgesia: no supplemental painkillers were requested neither in PACU neither in the first 24 hours. The day after surgery the patient was discharged from the hospital and no side effects were recorded.


The PECS II Block allowed to obtain an adequate intraoperative anaesthesia, preventing potential complications related to the difficult airway management. It also provided a good postoperative analgesia, a fast recovery and early hospital discharge.

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