eISSN: 1731-2531
ISSN: 1642-5758
Anaesthesiology Intensive Therapy
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vol. 54

Fascial plane blocks for breast surgery – current state of knowledge

Wojciech Gola
Szymon Białka
Agata Andrzejewska
Piotr Palaczynski
Hanna Misiołek

  1. Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
  2. Department of Anesthesiology and Intensive Care, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
  3. Department of Anesthesiology and Intensive Care, Pomeranian Medical University, Szczecin, Poland
Anaesthesiol Intensive Ther 2022; 54, 3: 262–270
Online publish date: 2022/09/02
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Breast surgeries belong to the most frequently performed procedures and are often associated with a high intensity of pain in the postoperative period. Regional anesthesia techniques, and paravertebral block, have been the gold standard of postoperative pain management for major breast cancer surgeries. In recent years, the development of new techniques of regional anesthesiology, which is due to the extensive implementation of ultrasound imaging, has enabled the use of a number of new blockades. The “new players” in regional anesthesiology include numerous fascial plane blocks. Fascial plane blocks are often technically easier and less invasive compared to, for example, paravertebral blockade. The core mechanism of action in fascial blocks consists in blocking the nerve structures that supply a certain area of the trunk after deposition of local anesthetic (LA) within the fascial and fasciomuscular compartments. In addition to direct nerve blockade, there are other potential mechanisms of analgesia such as systemic effects. This idea differs from the traditional concept of nerve and plexus blocks, but it should be remembered that the final effect of a fascial plane block and its extent can be extremely variable across individual cases. According to the current state of knowledge, an alternative to paravertebral blockade may be PECS blockade. The available options also include erector spinae plane block (ESPB) and serratus plane block (SPB), however their recommendation in breast surgery requires more extensive scientific evidence.

postoperative pain management, regional anesthesia, breast surgery, fascial plane blocks

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