PECS 1: Fascial plane block of anterior chest wall targeting LPN and branches of MPN
Provides somatic analgesia to anterolateral chest wall
LPN originates from lateral cord of BP (C5, C6, C7) or from anterior divisions of upper and middle trunks of BP
In chest wall, LPN passes across axillary artery and vein, pierces clavipectoral (coracoclavicular) fascia, and courses over PmM to split into several branches that innervate lateral portion of PMM
LPN is located adjacent to pectoral branch of thoracoacromial artery (landmark for block)
Branches of MPN pierce PmM and innervate medial portion of PMM
Modified PECS 1 a.k.a. PECS 2: Extended PECS 1 block that also covers ICBN, LTN, lateral cutaneous branches of intercostal nerves (T2-T6)
Provides somatic analgesia to anterolateral chest wall, including axilla
MPN arises from medial cord (C8-T1) and sometimes directly from anterior division of inferior trunk of BP
MPN pierces chest wall, then enters deep surface of PmM, where it divides into number of branches that supply muscle; branches pierce through muscle and into sternocostal head of PMM; MPN pierces both PmM and sternocostal head of PMM
ICBN originates as lateral cutaneous branch of T2 intercostal nerve and innervates axilla and cutaneous medial arm and courses through 2nd intercostal space and exits at lateral chest wall, piercing intercostal muscles and SAM and traveling into medial upper arm to provide sensation to axilla and medial arm
LTN originates from trunk of BP (C5, C6, C7), innervates SAM and provides sensation to lateral wall, and courses over SAM at midaxillary line adjacent to lateral thoracic vessels
Anesthetizing LTN causes anesthesia of SAM and consequential winged scapula for duration of local anesthetic
PREPROCEDURE
Indications
Contraindications
Getting Started
PROCEDURE
Patient Position/Location
Equipment Preparation
Procedure Steps
Findings and Reporting
Alternative Procedures/Therapies
POST PROCEDURE
Expected Outcome
Things to Do
Things to Avoid
OUTCOMES
Problems
Complications
Selected References
SoberĂ³n JR Jr et al: Novel use of the pecs II block in major vascular surgery: a case report. A A Pract. 13(4):145-7, 2019
Goswami S et al: Pectoral nerve block1 versus modified pectoral nerve block2 for postoperative pain relief in patients undergoing modified radical mastectomy: a randomized clinical trial. Br J Anaesth. 119(4):830-5, 2017
Henry BM et al: Origin, branching, and communications of the intercostobrachial nerve: a meta-analysis with implications for mastectomy and axillary lymph node dissection in breast cancer. Cureus. 9(3):e1101, 2017
Fusco P et al: The association between the ultrasound-guided serratus plane block and PECS I block can represent a valid alternative to conventional anesthesia in breast surgery in a seriously ill patient. Minerva Anestesiol. 82(2):241-2, 2016
Kikuchi M et al: [Difference in the spread of injectate between ultrasound guided pectoral nerve block I and II. a cadaver study.] Masui. 65(3):314-7, 2016
Kulhari S et al: Efficacy of pectoral nerve block versus thoracic paravertebral block for postoperative analgesia after radical mastectomy: a randomized controlled trial. Br J Anaesth. 117(3):382-6, 2016
Bouzinac A et al: Bilateral association of pecs I block and serratus plane block for postoperative analgesia after double modified radical mastectomy. Minerva Anestesiol. 81(5):589-90, 2015
Fujiwara S et al: Pectral nerve blocks and serratus-intercostal plane block for intractable postthoracotomy syndrome. J Clin Anesth. 27(3):275-6, 2015
Fujiwara A et al: Pectoral nerves (PECS) and intercostal nerve block for cardiac resynchronization therapy device implantation. Springerplus. 3:409, 2014
Leiman D et al: Medial and lateral pectoral nerve block with liposomal bupivacaine for the management of postsurgical pain after submuscular breast augmentation. Plast Reconstr Surg Glob Open. 2(12):e282, 2014
Purcell N et al: Novel use of the PECS II block for upper limb fistula surgery. Anaesthesia. 69(11):1294, 2014
Blanco R: The 'pecs block': a novel technique for providing analgesia after breast surgery. Anaesthesia. 66(9):847-8, 2011
Evans SR et al: Surgical Pitfalls: Prevention and Management. Philadelphia, PA: Saunders/Elsevier. 475-87, 2009
Bertelli JA et al: Long thoracic nerve: anatomy and functional assessment. J Bone Joint Surg Am. 87(5):993-8, 2005
Related Anatomy
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Related Differential Diagnoses
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References
Tables
Tables
KEY FACTS
Terminology
Procedure
Post Procedure
Outcomes
TERMINOLOGY
Abbreviations
Brachial plexus (BP)
Lateral pectoral nerve (LPN)
Medial pectoral nerve (MPN)
Pectoralis major muscle (PMM)
Pectoralis minor muscle (PmM)
Intercostobrachial nerve (ICBN)
Long thoracic nerve (LTN)
Serratus anterior muscle (SAM)
Synonyms
Pectoral nerve block
PECS 1 block; PECS 2 block
Definitions
PECS 1: Fascial plane block of anterior chest wall targeting LPN and branches of MPN
Provides somatic analgesia to anterolateral chest wall
LPN originates from lateral cord of BP (C5, C6, C7) or from anterior divisions of upper and middle trunks of BP
In chest wall, LPN passes across axillary artery and vein, pierces clavipectoral (coracoclavicular) fascia, and courses over PmM to split into several branches that innervate lateral portion of PMM
LPN is located adjacent to pectoral branch of thoracoacromial artery (landmark for block)
Branches of MPN pierce PmM and innervate medial portion of PMM
Modified PECS 1 a.k.a. PECS 2: Extended PECS 1 block that also covers ICBN, LTN, lateral cutaneous branches of intercostal nerves (T2-T6)
Provides somatic analgesia to anterolateral chest wall, including axilla
MPN arises from medial cord (C8-T1) and sometimes directly from anterior division of inferior trunk of BP
MPN pierces chest wall, then enters deep surface of PmM, where it divides into number of branches that supply muscle; branches pierce through muscle and into sternocostal head of PMM; MPN pierces both PmM and sternocostal head of PMM
ICBN originates as lateral cutaneous branch of T2 intercostal nerve and innervates axilla and cutaneous medial arm and courses through 2nd intercostal space and exits at lateral chest wall, piercing intercostal muscles and SAM and traveling into medial upper arm to provide sensation to axilla and medial arm
LTN originates from trunk of BP (C5, C6, C7), innervates SAM and provides sensation to lateral wall, and courses over SAM at midaxillary line adjacent to lateral thoracic vessels
Anesthetizing LTN causes anesthesia of SAM and consequential winged scapula for duration of local anesthetic
PREPROCEDURE
Indications
Contraindications
Getting Started
PROCEDURE
Patient Position/Location
Equipment Preparation
Procedure Steps
Findings and Reporting
Alternative Procedures/Therapies
POST PROCEDURE
Expected Outcome
Things to Do
Things to Avoid
OUTCOMES
Problems
Complications
Selected References
SoberĂ³n JR Jr et al: Novel use of the pecs II block in major vascular surgery: a case report. A A Pract. 13(4):145-7, 2019
Goswami S et al: Pectoral nerve block1 versus modified pectoral nerve block2 for postoperative pain relief in patients undergoing modified radical mastectomy: a randomized clinical trial. Br J Anaesth. 119(4):830-5, 2017
Henry BM et al: Origin, branching, and communications of the intercostobrachial nerve: a meta-analysis with implications for mastectomy and axillary lymph node dissection in breast cancer. Cureus. 9(3):e1101, 2017
Fusco P et al: The association between the ultrasound-guided serratus plane block and PECS I block can represent a valid alternative to conventional anesthesia in breast surgery in a seriously ill patient. Minerva Anestesiol. 82(2):241-2, 2016
Kikuchi M et al: [Difference in the spread of injectate between ultrasound guided pectoral nerve block I and II. a cadaver study.] Masui. 65(3):314-7, 2016
Kulhari S et al: Efficacy of pectoral nerve block versus thoracic paravertebral block for postoperative analgesia after radical mastectomy: a randomized controlled trial. Br J Anaesth. 117(3):382-6, 2016
Bouzinac A et al: Bilateral association of pecs I block and serratus plane block for postoperative analgesia after double modified radical mastectomy. Minerva Anestesiol. 81(5):589-90, 2015
Fujiwara S et al: Pectral nerve blocks and serratus-intercostal plane block for intractable postthoracotomy syndrome. J Clin Anesth. 27(3):275-6, 2015
Fujiwara A et al: Pectoral nerves (PECS) and intercostal nerve block for cardiac resynchronization therapy device implantation. Springerplus. 3:409, 2014
Leiman D et al: Medial and lateral pectoral nerve block with liposomal bupivacaine for the management of postsurgical pain after submuscular breast augmentation. Plast Reconstr Surg Glob Open. 2(12):e282, 2014
Purcell N et al: Novel use of the PECS II block for upper limb fistula surgery. Anaesthesia. 69(11):1294, 2014
Blanco R: The 'pecs block': a novel technique for providing analgesia after breast surgery. Anaesthesia. 66(9):847-8, 2011
Evans SR et al: Surgical Pitfalls: Prevention and Management. Philadelphia, PA: Saunders/Elsevier. 475-87, 2009
Bertelli JA et al: Long thoracic nerve: anatomy and functional assessment. J Bone Joint Surg Am. 87(5):993-8, 2005
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