I’ve been hearing more and more about PEC 2 block for mastectomy. What’s wonderful about this block is that it seems that the risk of pneumothorax is lower than for a paravertebral block.
SlideShare powerpoint: PEC 1 & 2 and Serratus Anterior Blocks
Current Anesthesiol Rep, 2015. Regional Anesthesia for Breast Surgery: Techniques and Benefits.
TAP, PEC 1, & PEC 2 Blocks PPT
Anaesthesia, 2013. Serratus Plane Block: A Novel Ultrasound-Guided Thoracic Wall Nerve Block.
NYSORA 2014: Update on truncal blocks
Summary:
- U/S guidance: probe position similar to infraclavicular block. Find 3rd, 4th rib.
- Pt position: Head away from side of block. Ipsilateral arm abducted.
- PEC 2: Inject 20 ml 0.25% bupi between pec minor and serratus.
- PEC 1: Inject 10 ml 0.25% bupi between pec major and pec minor.
- Serratus: 5th rib, mid-axillary line. Inject 30 ml 0.125% bupi along top (superficial) and bottom (deep) of serratus muscle (which is just deep to the latissmus dorsi).
Sleepy Time 
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