LKnative – PECS blocks

Indications

Postoperative analgesia after breast surgery as an alternative to thoracic epidural or thoracic paravertebral blocks

Pecs I: analgesia after insertion of breast expanders and sub pectoral prosthesis, pacemakers, porth-a-caths and chest drains

Pecs II: analgesia of (1) the axilla – required for axillary clearance and (2) intercostal nerves – required for wide excisions including several types of mastectomies and sentinel node biopsy

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Anatomy: The medial and lateral pectoral nerves

The lateral pectoral nerve typically origins from the spinal nerve roots C5-C7 and branches off the lateral cord of the brachial plexus

It runs across the superior-medial margin of the minor pectoral muscle piercing the clavipectoral fascia (see next page) and enters the fascial space between the minor and major pectoral muscles; it innervates the two pectoral muscles

The medial pectoral nerve origins from C8-T1 and branches off the medial cord of the brachial plexus

It typically pierces the minor pectoral muscle and enters the fascial space between the minor and major pectoral muscles; it innervates the two pectoral muscles

The two pectoral nerves run adjacent to the pectoral branch of the thoracoacromial artery in the fascial space between the minor and major pectoral muscles