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Chapter 34. Pectoralis and Serratus Plane Blocks

Which of the following is not an advantage of performing a pectoralis nerve (Pecs) block over thoracic paravertebral block (TPVB) for breast surgery such as a modified radical mastectomy?

A. Local anesthetic requirement is lower in Pecs block

B. Longer duration of action for the Pecs block

C. Lower consumption of opioids in the postoperative 24-hour period

D. Reduced postoperative pain scores in patients receiving Pecs block

A is not an advantage, so option A is correct. In a randomized control trial by Kulhari et al, patients undergoing modified radical mastectomy were allocated to two groups. One group received a Pecs block while the other underwent a TPVB. Both groups received the same amount of local anesthetic, 25 mL of 0.5% ropivacaine.

B and C are advantages, so options B and C are incorrect. The study demonstrated a longer duration of analgesia postoperatively as well as a lower consumption of morphine in the immediate postoperative 24-hour period.

D is an advantage, so option D is incorrect. Postoperative pain scores were lower in the Pecs group in the immediate 2 hours after surgery.

Compared to a thoracic paravertebral block (TPVB), which of the following complications is unique to a Pecs block?

A. Bradycardia

B. Hypotension

C. Injury to the thoracodorsal or long thoracic nerve

D. Pleural puncture

C is correct. Injury to the thoracodorsal and long thoracic nerve is unique to the Pecs block.

A, B, and D are incorrect. The Pecs block avoids the possibility of midline spread that can occur with TPVB and prevents complications associated with sympathetic blockade that can be seen with TPVB. Both procedures can cause pneumothorax and pleural puncture.

Which is true concerning Pecs I versus Pecs II blocks?

A. No difference in technique is noted by performing the procedure preoperatively or postoperatively.

B. Pecs I block is preferred for modified radical mastectomy.

C. Pecs II block does not provide adequate coverage for insertion of a pacemaker.

D. Pecs II block should be performed prior to Pecs I in order to preserve anatomy visualized under ultrasound.

D is correct. When a Pecs I block is made before a Pecs II, it makes ...

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