PEC I and II Nerve Block For Post Operative Pain Control After Mini-Thoracotomy

The PEC I and II nerve block aims at anesthetizing the lateral and medial pectoral nerves of the brachial plexus which supply the major and minor pectoral muscles from dermatomes T2-T6 including the axillary region, making it an ideal block for most chest wall surgeries. A recent randomized clinical trial showed that the PECS block in addition to GA for breast cancer surgery significantly lowered pain scores as well as post-operative opioid consumption. Surprisingly, there have not been many publications describing the use of the pectoral nerve blocks for other chest wall surgeries. Therefore, the authors of this case report were interested in the efficacy of the PECS block in thoracic surgical procedures as an alternative to the intercostal and epidural block. We performed a post-operative PECS block in a 22 year old male with severe left ventricular dysfunction and CHF after a mini-thoracotomy for repair of a malfunctioning AICD. In the PACU the patient reported a pain scale of 8/10 and had inspiratory volume of 1500ml’s. After performing the PEC block using ultrasound guidance, we minimized his pain scale to 2/10 and increased his inspiratory volume to 2500ml’s. The patient also reported the ability to raise his left arm with ease, something he couldn’t do without severe pain moments prior to the block. This successful attempt at minimizing a patient’s post-operative pain after thoracic surgery will hopefully open the gateway to performing this block more frequently in other types of chest wall surgeries, both for intraoperative and post-operative analgesia.