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Case Reports
. 2017 Apr;45(2):112-115.
doi: 10.5152/TJAR.2017.43815. Epub 2017 Apr 1.

Ultrasound-Guided Continuous Interpectoral Block for Patient Undergoing Mastectomy and Axillary Clearance

Mario Fajardo-Pérez  1 , Ece Yamak Altınpulluk  2 , Javier García-Miguel  3 , Borja Quintana-Gordon  1
Affiliations
Case Reports

Ultrasound-Guided Continuous Interpectoral Block for Patient Undergoing Mastectomy and Axillary Clearance

Mario Fajardo-Pérez et al. Turk J Anaesthesiol Reanim. 2017 Apr.

Abstract

Using a single dose of local anaesthetics has some disadvantages and provides limited analgesia depending on the pharmacokinetic characteristics of the local anaesthetic used. Nevertheless, the use of continuous perineural infusions allows sustained pain control. Ultrasound-guided interpectoral block followed by the placement of catheters in patients undergoing mastectomies with or without lymph node axillary dissections can result in sufficient pain control. We present a case of a 58-year-old woman undergoing mastectomy and axillary clearance who received ultrasound-guided continuous interpectoral block for postoperative analgesia. After the induction of general anaesthesia, interpectoral ultrasound block was performed and levobupivacaine was administered through a catheter placed between the pectoralis minor and pectoralis major muscles using an ultrasound-guided technique. We used an elastomeric pump containing the 0.125% levobupivacaine anaesthetic solution, with an infusion rate of 5 mL h-1 for 48 h. Excellent postoperative pain control was observed. Local anaesthetic- and catheter-related side-effects were not observed. The ideal infusion rate for interpectoral block in patients under mastectomy has not been determined. More randomised studies are needed to confirm whether interpectoral techniques are appropriate for routine clinical practice.

Keywords: Mastectomy and axillary clearance; continuous interpectoral block; pain control.

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Conflict of interest statement

Conflict of Interest: No conflict of interest was declared by the authors.

Figures

Figure 1
Figure 1
Ultrasound image of the anterior thoracic wall shows the pectoralis major muscle (PMM), pectoralis minor muscle (pmm), superficial pectoral fascia (SPF), acromiothoracic artery (ATA), clavipectoral fascia (CPF), parietal plaeura (PP), lateral pectoral nerve, intercostal muscle (ICM) and ribs (R)
Figure 2a–c
Figure 2a–c
(a) Ultrasound image shows probe placement and needle insertion. (b) Local anaesthetic (LA) (c) Ultrasound image of the anterior thoracic wall shows the pectoralis major muscle (PMM), pectoralis minor muscle (pmm) and catheter
See this image and copyright information in PMC

References

    1. Perez MF, Duany O, de la Torre PA. Redefining PECS Blocks for Postmastectomy Analgesia. Reg Anesth Pain Med. 2015;40:729–30. https://doi.org/10.1097/AAP.0000000000000243. - DOI - PubMed
    1. Blanco R. The ‘pecs block’: a novel technique for providing analgesia after breast surgery. Anaesthesia. 2011;66:847–8. https://doi.org/10.1111/j.1365-2044.2011.06838.x. - DOI - PubMed
    1. Sopena-Zubiria LA, Fernandez-Mere LA, Valdes Arias C, Munoz Gonzalez F, Sanchez Asheras J, Ibanez Ernandez C. Thoracic paravertebral block compared to thoracic paravertebral block plus pectoral nerve block in reconstructive breast surgery. Rev Esp Anestesiol Reanim. 2012;59:12–7. https://doi.org/10.1016/j.redar.2011.10.001. - DOI - PubMed
    1. Sarhadi NS, Shaw Dunn J, Lee FD, Soutar DS. An anatomical study of the nerve supply of the breast, including the nipple and areola. Br J Plast Surg. 1996;49:156–64. https://doi.org/10.1016/S0007-1226(96)90218-0. - DOI - PubMed
    1. Sarhadi NS, Shaw-Dunn J, Soutar DS. Nerve supply of the breast with special reference to the nipple and areola: Sir Astley Cooper revisited. Clin Anat. 1997;10:283–8. https://doi.org/10.1002/(SICI)1098-2353(1997)10:4<283::AID-CA12>3.0.CO;2-G. - DOI - PubMed

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