![]() The apex of the axilla is supplied by the intercostobrachialis nerve this is a cutaneous branch of the second intercostal nerve (T2). The innervation of the breast is supplied mainly by the anterior branches of the 4 th, 5th and 6th intercostal nerves which arise from the thoracic spinal nerves (T4-6). It should be noted that blockade of the long thoracic and thoracodorsal nerves usually requires a serratus anterior plane block. They are simple to perform, reduce postoperative analgesic requirements and avoid the use of more invasive techniques such as paravertebral blockade.īilateral blocks and catheter insertions for continuous infusion can also be used for both Pecs blocks. ![]() Using ultrasound guidance local anaesthetic is placed between the muscles of the thoracic wall. The Pecs I and Pecs II blocks are superficial thoracic wall blocks which through blockade of the pectoral and intercostal nerves can be used to provide analgesia for breast surgery and other procedures / surgery involving the anterior chest wall. Ultrasound guidance is required for the block.More extensive procedures may require blockade of the supraclavicular nerves or a serratus plane block. ![]() Pecs II block – Pecs I block and an additional injection between pectoralis minor and serratus anterior which blocks the intercostal and intercostobrachial nerves.Pecs I block – a single injection between pectoralis major and pectoralis minor muscles which blocks the lateral and medial pectoral nerves.Pecs blocks are thoracic regional fascial plane blocks useful for breast surgery and procedures involving the chest wall.Ultrasound is not needed to perform Pecs blocks. Pecs II is performed at the level of the 5 th-6 th ribsĮ. Catheter insertions are possible for continuous infusion analgesia.ĭ. Pecs block can be performed as rescue analgesia.ī. Between serratus anterior and latissimus dorsi musclesĪ. Between pectoralis minor and the serratus anterior musclesĬ. Between pectoralis major and minor musclesī. The following is the target in Pecs II block:Ī.The following are indications for Pecs I or II block:.The answers can be found at the end of the article, together with an explanation. Before continuing, try to answer the following questions.
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