372 posters, 1 audios, 13 topics, 29 sessions, 1,035 authors, 449 institutions

51st Annual Regional Anesthesiology and Acute Pain Medicine Meeting

April 16 - 18, 2026 | Phoenix, Arizona

2316087

Chest Wall Blocks as Anesthetic Adjuncts in Oncologic Surgery for High-Risk Patients

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Poster Presenter

Sunny Gotewal

Authors

Sunny Gotewal, Andrzej Kwater, Adebukola Owolabi, Edward Tsai, Alec Hendon, Jessy Kurian, Cassius Mensah

Affiliations

Baylor College of Medicine, The University of Texas MD Anderson Cancer Center

Part of Topic

Medically Challenging Cases

Introduction

- Breast oncologic surgery can contribute to significant intraoperative nociceptive and sympathetic activation.

- High-risk cardiac patients are vulnerable to hemodynamic instability and surgical stress response.

- Pecto-serratus (PECS II) and pecto-intercostal fascial plane (PIFP) blocks provide anterolateral chest wall analgesia à reduce opioid use and perioperative stress response.

Methods

Pecto-serratus block (PECS II):

- Probe in oblique orientation along lateral chest wall

- LA deposited between pectoralis minor and serratus anterior muscles

PIFP block:

- Parasagittal placement of probe near sternum (T2–T4)

- LA between pectoralis major and internal intercostal muscles

Local Anesthetic Formulations

Case 1: Pecto-serratus + PIFP

- 30 mL 0.5% bupivacaine with PF Dexamethasone 10 mg

Case 2:

- Intercostobrachial (ICB) nerve block: 5 mL 0.5% bupivacaine with PF dexamethasone 2 mg

- Pecto-serratus block: 20 mL 0.5% bupivacaine with PF dexamethasone 8 mg

Case Reports

Case 1

- 87-year-old female

- Mucinous breast carcinoma

- Moderate AS, moderate MR + SSS (pacemaker) + pulmonary HTN

- Right segmental mastectomy

- Blocks: PECS II + PIFP

- 30 mL 0.5% bupivacaine + 10 mg dexamethasone

- Hemodynamically stable

- No perioperative opioids

- PACU pain: 0/10

Case 2

- 87-year-old female

- Forearm melanoma

- Severe rheumatic mitral stenosis + AFib

- Axillary LN excision

- ICB nerve block + PECS II

- 25 mL 0.5% bupivacaine + 10 mg dexamethasone

- Stable intraoperative course

- Minimal postoperative pain

- Same-day discharge

Discussion

Key Points

- Chest wall blocks attenuate nociceptive and sympathetic activation during surgery

- Reduced perioperative stress response lowers myocardial oxygen demand à essential in high-risk cardiac patients

- Opioid minimization is critical in elderly patients.

- Blocks serve as hemodynamic stabilizers, not just analgesic adjuncts.

- Regional anesthesia facilitates effective perioperative care in high-risk patients and reduces complications as well as prolonged hospital stay

Chest wall fascial plane blocks may serve as essential anesthetic adjuncts in high-risk cardiac patients undergoing breast and axillary oncologic procedures.