Awake breast surgeries under nerve blocks have been a challenge for anaesthesiologists, and different block combinations have been used for surgery under sedation. Thoracic paravertebral block (TPVB) was thought to be sufficient alone for surgical anaesthesia of the breast. We performed a combination of TPVB, pectoralis nerve I block, and serratus anterior plane block for awake breast surgery in an elderly patient with serious comorbidities. Surgical anaesthesia was achieved, excluding skin incision. Any regional anaesthesia technique alone is not sufficient; rather, multiple thoracic wall blocks are needed for surgical anaesthesia of the breast.
Keywords: Awake surgery; PECS block; breast surgery; serratus anterior plane block; thoracic paravertebral block.