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51st Annual Regional Anesthesiology and Acute Pain Medicine Meeting
April 16 - 18, 2026 | Phoenix, Arizona
2317182
Use of a PEC II block for chest wall reconstruction in a patient with Poland Syndrome
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Medically Challenging Cases
Background: Poland Syndrome is a rare,sporadic, congenital disorder, associated withhypoplasia or agenesis of the pectoralis majormuscle. The syndrome often presents unilaterallyand right sided. Anesthetics for chest wallreconstruction for patients with Poland Syndromeare scarcely described and omit regionaltechniques.
Case Details:
A 51-year-old 90 kg male with Poland Syndrome,HTN, OSA, and depression presented for electiveright chest wall reconstruction under generalanesthesia. After induction, using ultrasoundguidance, the right 4th rib was identified with asmall overlying fascial band as the target for localinjection. A total of 25 mL of 0.25% bupivacainewith 22 mcg of dexmedetomidine wereadministered into this fascial plane. While this isan off-label use of dexmedetomidine, it is welldescribed in prolonging the duration of regionalblocks (Reel and Maani). Intraoperatively, hereceived 100 mcg of fentanyl with induction andno other opioids or analgesics. In PACU, thehighest VAS was 3/10 for which he requested adose of 5mg oxycodone. The following 2 days, thepatient was called and reported excellent paincontrol, with minimal need for narcotic.
Discussion:
This case report describes the successfuluse of the 4th rib as the backstop or targetfor a PECs II block in the absence of ordifficult to find pectoralis minor muscle. Itappears that in the absence of normalanatomic and ultrasound landmarks, theremay be a role for regional techniques forpost operative pain management forpatients with Poland Syndrome that areundergoing superficial chest wallreconstruction.
An alternative explanation for adequateanalgesia could be explained by aplasia orhypoplasia of the cutaneous and sensorytissue of the right chest wall. Absence ofthese nerves would imply a lack of utility inperforming a Pecs block. A 2002 review onPoland syndrome describes the prevailingtheory that interrupted embryonic bloodsupply causes hypoplasia of the ipsilateralsubclavian artery or its branch after the sixthweek of gestation (Fokin and Robicsek).Whether this would lead tounderdevelopment or absence of neuraltissue is unclear.