Regional for breast reduction survey

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Paravertebrals for regional anesthesia. I have used Pec blocks for post-op analgesia. I have seen erector spinae used with variable benefit but nobody can actually explain to me how that works, and the research isn’t as robust.
 
The regional for breast surgery is new to me but I am good in blocks and using ultrasound. So you think pecs1 and 2 be sufficient for breast reduction surgery? Do I have to add serratus anterior block? Should I ask surgeon to supplement with local to skin?
 
somedumbDO said:
Pec blocks alone are sufficent
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You only need PECS II (the inyection between the pectoral minor and serratus anterior muscles. The PEC I (inyection between both pectoral muscles) doesn't really provide any benefit for a breast reduction, since it only blocks the pectoral muscles, not the skin or mammary gland. You could also get about with a Serratus block, which is like PECS II but lateral.

PVB is the only one that will give you surgical anesthesia for any breast surgery though. ESP is a good alternative, but for analgesia.
 
JWebar said:
You only need PECS II (the inyection between the pectoral minor and serratus anterior muscles. The PEC I (inyection between both pectoral muscles) doesn't really provide any benefit for a breast reduction, since it only blocks the pectoral muscles, not the skin or mammary gland. You could also get about with a Serratus block, which is like PECS II but lateral.

PVB is the only one that will give you surgical anesthesia for any breast surgery though. ESP is a good alternative, but for analgesia.
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Hate to be finicky with nomenclature, and I know this is not what the point of your statement was, but a PECS II block technically is a 2 injection block - it includes a PECS I + the deeper injection superficial to SA. The deep injection portion of PECS II when performed alone is a version of serratus anterior block (the superficial variation).
 
Pluto201 said:
Hello everyone, what regional works best for breast reduction surgery?

Thanks!
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If you want an actual good/dense block (i.e. opioid-free post-op) and have the ability, do bilateral PVBs T3+T5. If you aren't block-savvy and experienced, do the much easier fascial plane blocks (ESP or SAP). Most institutions have gone away from doing PVBs given the risk and learning curve. Would only recommend doing PVBs if you have been properly taught. Definitely the hardest/riskiest nerve block to perform for beginners.
 
ethilo said:
Hate to be finicky with nomenclature, and I know this is not what the point of your statement was, but a PECS II block technically is a 2 injection block - it includes a PECS I + the deeper injection superficial to SA. The deep injection portion of PECS II when performed alone is a version of serratus anterior block (the superficial variation).
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Indeed, you are right, thats why I specified to do the deep injection. I should have said "ONLY the injection between pec minor and serratus". This is a very good point cause the nomenclature in regional anesthesia is complete nonsensical. Everyone is obsessed to invent something. There are 3 types of QL for christ sakes. It only brings them farther from people that want to learn this techniques and include them in their arsenal.
 
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