Ultrasound-Guided Interpectoral and Pectoserratus Plane Blocks in Breast Surgery: An Alternative Option to General Anaesthesia in an Elderly Woman with a Complex Medical History

Abstract

With an incidence of over 1.5 million worldwide per annum, breast cancer continues to be the most common cancer affecting the female population. The main and most effective treatment in over 40% of these patients is a primary neoplasm resection. General anaesthesia, at times in association with loco-regional anaesthetics, is the most commonly used anaesthesia technique for radical mastectomies. Nausea, vomiting, and considerable postoperative pain, which are commonly experienced side effects and complications of general anaesthesia, tend, however, to augment most patients' post-surgical morbidity. A growing body of research has shown that loco-regional anaesthesia often used together with and, in some cases, in the substitution of general anaesthesia can be a safe, effective alternative. This work is a case report regarding a 94-year-old elderly patient who was anaesthetised during a left radical mastectomy using exclusively combined interpectoral and pectoserratus plane blocks.

Keywords: PECS II block; age; dementia; fascia; fascial block; opioids sparing; regional anaesthesia; ultrasound.

Figure 1

(A) A left radical mastectomy due to breast cancer and positive sentinel lymph node biopsy in an elderly female patient. (B) Combined interpectoral and pectoserratus plane blocks: a 50 mm Pajunk echogenic needle was used to inject ropivacaine 0.5% 10 mL (+: in the inter-fascial plane between the major and minor pectoralis muscles) + 20 mL (*: in the inter-fascial plane between the pectoralis minor and serratus anterior muscles).