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The Use of Pectoralis Blocks in Breast Surgery: A Practice Advisory and Narrative Review from the Society for Ambulatory Anesthesia (SAMBA)

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Although pectoralis (PECS) blocks are commonly used for breast surgery, recommendations regarding the efficacy of these blocks have thus far not been developed by any professional anesthesia society. Given the potential impact of PECS blocks on analgesia after outpatient breast surgery, The Society for Ambulatory Anesthesia (SAMBA) convened a task force to develop a practice advisory on the use of this analgesic technique. In this practice advisory, we compare the efficacy of PECS blocks with systemic analgesia, local infiltration anesthesia, and paravertebral blockade. Our objectives were to advise on two clinical questions. (1) Does PECS-1 and/or -2 blockade provide more effective analgesia for breast-conserving surgery than either systemic analgesics or surgeon-provided local infiltration anesthesia? (2) Does PECS-1 and/or -2 blockade provide equivalent analgesia for mastectomy compared with a paravertebral block (PVB)? Among patients undergoing breast-conserving surgery, PECS blocks moderately reduce postoperative opioid use, prolong time to analgesic rescue, and decrease postoperative pain scores when compared with systemic analgesics. SAMBA recommends the use of a PECS-1 or -2 blockade in the absence of systemic analgesia (Strength of Recommendation A). No evidence currently exists that strongly favors the use of PECS blocks over surgeon-performed local infiltration in this surgical population. SAMBA cannot recommend PECS blocks over surgical infiltration (Strength of Recommendation C). For patients undergoing a mastectomy, a PECS block may provide an opioid-sparing effect similar to that achieved with PVB; SAMBA recommends the use of a PECS block if a patient is unable to receive a PVB (Strength of Recommendation A).

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Funding

No sources of funding were used to assist in the preparation of this article.

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Authors and Affiliations

  1. Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL, USA

    Alberto E. Ardon MD, MPH, Sarah McLaughlin MD & Roy A. Greengrass MD

  2. Cleveland Clinic, Cleveland, OH, USA

    John E. George III MD

  3. Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India

    Kapil Gupta MD

  4. Loyola University and Edward Hines Jr, VA Hospital, Chicago, IL, USA

    Michael J. O’Rourke MD

  5. University of Iowa, Iowa City, IA, USA

    Melinda S. Seering MD & Ingrid Lizarraga MBBS

  6. Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Hanae K. Tokita MD & Tracy-Ann Moo MD

  7. Medical University of South Carolina, Charleston, SC, USA

    Sylvia H. Wilson MD

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Contributions

AEA, SHW, and RAG helped formulate the systematic review strategy, contributed to the literature search, reviewed articles, and helped write and edit the manuscript. JEG III, KG, and MSS helped with the literature search, reviewed articles, and helped write the manuscript. MJO’R and HKT helped with the literature search, reviewed articles, and helped write and edit the manuscript. T-AM, IL, and SMcL reviewed articles and helped edit the manuscript. All authors reviewed and approved the final manuscript.

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Correspondence to Alberto E. Ardon MD, MPH.

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Disclosures

Alberto E. Ardon, John E. George III, Kapil Gupta, Michael J. O’Rourke, Melinda S. Seering, Hanae K. Tokita, Sylvia H. Wilson, Tracy-Ann Moo, Ingrid Lizarraga, Sarah McLaughlin, and Roy A. Greengrass have no conflicts of interest to declare.

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Ardon, A.E., George, J.E., Gupta, K. et al. The Use of Pectoralis Blocks in Breast Surgery: A Practice Advisory and Narrative Review from the Society for Ambulatory Anesthesia (SAMBA). Ann Surg Oncol 29, 4777–4786 (2022). https://doi.org/10.1245/s10434-022-11724-9

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