Pectoralis I and II Blocks
Blockade of the long thoracic or thoracodorsal nerves requires a serratus anterior plane block
Pectoralis blocks are superficial plane blocks used to provide analgesia to the anterior chest wall by blockade of pectoral and intercostal nerves.
Pecs I block:
- Plane block between pectoral muscles
- Aims to block median and lateral pectoral nerves
Indications
Contraindications
Anatomy
Layers of the chest wall:
- Skin
- Subcutaneous tissue
- Pectoralis major
- Pectoralis minor
- Serratus anterior
Present more laterally. - Ribs and intercostal muscles
Equipment
- High frequency linear probe
- 50-100mm regional needle
- 0.4ml/kg of 0.25% levobupivacaine or 0.375% ropivacaine
Technique
- Position supine
- For Pecs I:
- Identify coracoid process on ultrasound in a sagittal plane
- Rotate the probe in place to identify the thoracoacromial artery
Lies in target plane between pectoralis major and pectoralis minor. Identifying serratus anterior in the same view allows the Pecs II block to be performed with the same injection. - Advance needle from superomedial to inferolateral into the plane between pectoralis major and minor
- Inject 0.2ml/kg of LA
- For Pecs II:
- Place probe in mid-clavicular line and angle infero-laterally
- Identify axillary artery and vein
- Translate probe laterally until pectoralis minor and serratus anterior are identified
- Advance needle from superomedial to inferolateral into the plane between pectoralis minor and serratus anterior
- Inject 0.2ml/kg of LA