A Novel Ultrasound-Guided Block: A Promising Alternative for Breast Analgesia

We read with interest “Breast Augmentation and Augmentation-Mastopexy With Local Anesthesia and Intravenous Sedation,” by Colque and Eisemann.1 The article prompted us to share with your readers the novel ultrasound-guided anesthetic techniques we use in breast surgery. The intercostal nerve block (ICNB) is traditionally performed using surface anatomical landmarks. Although it is a “blind” technique, ICNB is technically simple to perform, has a high success rate, and has a relatively low overall complication rate. The use of ultrasonography in regional anesthesia allows for visualization of soft tissues and vessels, which in turn improves the accuracy of needle placement.2 We have been performing a relatively new regional anesthetic ultrasound-guided technique in patients who undergo major or minor breast surgery, which has led to decreased systemic perioperative pain, lower analgesic requirements, and improved patient satisfaction.3 In this letter, we introduce 2 new ultrasound-guided techniques. The first is the pecto-intercostal fascial block (PIFB), which consists of injecting a local anesthetic (LA) between the pectoralis major muscle (PMM) and the external intercostal muscle (EIM), in the interfascial plane where the anterior cutaneous branch emerges from the lateral side of the sternal bone. The second technique, known as the serratus intercostal …