15 Technique of Surgeon-Performed Intraoperative Regional Pectoral Nerve Block for Patients Undergoing Mastectomy

Background

Over 100,000 mastectomies are performed each year, though the use of regional anesthesia has been reported as only 13.8% in 2018. Regional and local anesthesia, such as the interfascial pectoral nerve (PECs) block, can be useful in limiting the use of opioids, though these blocks are still underutilized. Regional blocks are typically administered by anesthesia providers under ultrasound guidance, rather than intraoperatively by the operating surgeon. Our goal was to evaluate the use of opioids postoperatively after mastectomy with a PECs block given intraoperatively by the performing surgeon in the infraclavicular space and interpectoral (Rotter’s) space, consistent with a PECs I block.

Materials and Methods

Eighteen patients who underwent mastectomy from 2022 to 2025 were given an intraoperative regional PECs block during their procedure. When the breast tissue was removed and muscle exposed, 10 cc of 0.5% bupivacaine hydrochloride was injected into the soft tissue along the inferior margin of the clavicle, and 5 cc of 0.5% bupivacaine hydrochloride was injected into the interpectoral (Rotter’s) space by the operating surgeon (Figure). Patients were given a prescription for oxycodone/acetaminophen to take if their pain was not controlled without narcotics. At their follow-up visit, patients were asked if they required oxycodone/acetaminophen or not, and results were recorded. These results were reviewed retrospectively to assess the efficacy of the block in limiting opioid use.

Results

Ages of the patients ranged from 38 to 86 years old. One patient was male, and the other 17 were female patients. Only 3 patients out of the 18 (16.6%) required the oxycodone/acetaminophen for pain control.

Conclusions

As breast surgeries continue to advance, their pain management techniques also evolve. In recent years, the use of regional blocks such as the PECs blocks, including PECs I and PECs II, have gained attention as effective analgesia for patients undergoing mastectomy. Studies have demonstrated that PECs blocks reduce postoperative pain and decrease opioid consumption, allowing patients to recover comfortably while avoiding the adverse effects of opioid use. Some studies have shown that intraoperative injection of local anesthesia by the operating surgeon has a similar effect on pain as the anesthesia-administered PECs blocks, so our study aimed to determine the effect of intraoperative surgeon-administered PECs block on patients’ opioid consumption. Our study showed that only 3 out of 18 patients (16.6%) required opioids for post-operative pain. The intraoperative infraclavicular and interpectoral block is a fast and effective method of analgesia, and further studies should be conducted to optimize the technique.