Intra-operative Pectoral Nerve Block under direct vision – does it save theatre time for breast surgery ?

Abstract

Background: Pectoral nerve blocks have gained increasing recognition for effective postoperative pain relief following simple and modified radical mastectomy. Traditionally this is administered preoperatively by anaesthetist under ultrasound guidance, which adds significantly to the total procedure time. An alternative delivery method is direct injection by the operating surgeon intraoperatively under direct vision and using anatomical landmarks. We collected data on 36 patients undergoing mastectomy or wide local excision with axillary node clearance from 2018-2019. Each patient was asked to document their post-operative subjective pain scores and analgesia used for seven days post-operatively. These results show good efficacy for plain sighted injection, with post-operative pain well managed on sub-maximal analgesia regimens. This suggests that nerve block under direct vision offers significant time and efficiency benefits to theatre lists while maintaining satisfactory analgesic effect for patients.