title: Intraoperative Placement of Pectoral Nerve Block Catheters: Description of a Novel Technique and Review of the Literature.
abstract: Regional and neuraxial anesthesia for pain management after breast surgery is not widely used despite data showing improved postoperative pain control and patient satisfaction scores. We report a case of a 61-year-old woman who underwent bilateral mastectomies, and received postoperative analgesia via pectoral nerves 1 and 2 nerve blocks. This case highlights a previously undescribed technique of prolonged postoperative pain control by intraoperative placement of pectoral nerves 1 and 2 regional anesthesia catheters under direct visualization. Intraoperative placement has the potential benefits of more accurate plane targeting, time saving, and widening the scope of use to practitioners are not trained in the ultrasound guided technique. We also present a review of the regional block techniques and present a preliminary algorithm for the selection of block method in breast surgery.
authors.affiliation: From the *Division of Plastic Surgery, Department of Surgery, and †Department of Anesthesiology and Pain Medicine, University of California-Davis Medical Center, Sacramento, CA.
authors.forename: Katharine M
authors.initials: KM
authors.lastname: Hinchcliff
authors.forename: Jared R
authors.initials: JR
authors.lastname: Hylton
authors.forename: Hakan
authors.initials: H
authors.lastname: Orbay
authors.forename: Michael S
authors.initials: MS
authors.lastname: Wong
mesh_terms: D000465:Algorithms; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008408:Mastectomy; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D059408:Pain Management / Q000379:methods*; D010149:Postoperative Pain / Q000517:prevention & control*; D013900:Thoracic Nerves