Ultrasound description of Pecs II (modified Pecs I): a novel approach to breast surgery

Rev Esp Anestesiol Reanim. 2012 Nov;59(9):470-5. doi: 10.1016/j.redar.2012.07.003. Epub 2012 Aug 29.


Objective: The Pecs block (pectoral nerves block) is an easy and reliable superficial block inspired by the infraclavicular block approach and the transversus abdominis plane blocks. Once the pectoralis muscles are located under the clavicle the space between the two muscles is dissected to reach the lateral pectoral and the medial pectoral nerves. The main indications are breast expanders and subpectoral prosthesis where the distension of these muscles is extremely painful.

Material and methods: A second version of the Pecs block is described, called "modified Pecs block" or Pecs block type II. This novel approach aims to block at least the pectoral nerves, the intercostobrachial, intercostals III-IV-V-VI and the long thoracic nerve. These nerves need to be blocked to provide complete analgesia during breast surgery, and it is an alternative or a rescue block if paravertebral blocks and thoracic epidurals failed. This block has been used in our unit in the past year for the Pecs I indications described, and in addition for, tumorectomies, wide excisions, and axillary clearances.

Results and conclusions: The ultrasound sequence to perform this block is shown, together with simple X-ray dye images and gadolinium MRI images to understand the spread and pathways that can explain the benefit of this novel approach.

MeSH terms

  • Breast Implantation
  • Contrast Media
  • Female
  • Gadolinium
  • Humans
  • Injections
  • Intercostal Nerves / diagnostic imaging*
  • Intercostal Nerves / drug effects
  • Magnetic Resonance Imaging
  • Mammaplasty / methods*
  • Nerve Block / methods*
  • Pain, Postoperative / physiopathology
  • Pain, Postoperative / prevention & control
  • Pectoralis Muscles / diagnostic imaging*
  • Pectoralis Muscles / innervation
  • Thoracic Nerves / diagnostic imaging*
  • Thoracic Nerves / drug effects
  • Tissue Expansion Devices
  • Ultrasonography


  • Contrast Media
  • Gadolinium