2023, Vol. 6, Issue 3, Part A

In a radical mastectomy, the whole axillary lymph nodes, nipple, breast and pectoralis muscles are excisioned. Mastectomy requires general anesthesia or an advanced regional block with sedation like: erector spinae plane block (ESPB) or interfacial plane block (SIFB). ESPB can be done by single-injection or via catheter placement and can be carried out by deep or superficial needle technique. When carried out at T 4-5 level for breast surgeries, ESP block provides efficient postoperative analgesia. SIFB is described as anesthesia of the anterolateral chest wall through blockage of the intercostobrachial nerve. It may be single injection or continuous with catheter insertion unilateral or bilateral. 3 mL of LA per dermatome was a sufficient blockage of the lateral and anterior intercostal branches, inducing complete breast sensory loss. The complications of ESPB are very rare. But there are some complications for SIFB as pneumothorax secondary to the proximity of the pleura, intravascular injection, local anesthetic systemic toxicity, hematoma, inadequate or failed block, infection, hemothorax, nerve injury. There are technical and clinical advantages of ESPB and SIFB. Also, there are absolute and relative contraindications for both blocks.