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Pectoral Nerve Block (the Pecs Block)
The pectoral nerves are branches of the brachial plexus that innervate the pectoral muscles. The lateral pectoral nerve (C5, C6, C7) is often a branch of the lateral cord and innervates the pectoralis major muscle. The medial pectoral nerve (C8, T1) is often a branch of the medial cord and innervates both the pectoralis major and minor muscles. The lateral and medial pectoral nerves communicate via the ansa pectoralis that crosses the second part of the axillary artery, just distal to the thoracoacromial takeoff. The pectoral nerves have no cutaneous branches.
Several variations of pectoral nerve block have been described. These blocks are often used to provide postoperative analgesia for surgeries of the chest wall and sub-pectoral breast implants.
Suggested Technique
The approach for pectoral nerve block is similar to infraclavicular block of the brachial plexus. The lateral pectoral nerve travels with the pectoral branch of the thoracoacromial artery. The pectoral nerves can be blocked in the fascial plane between the pectoralis major and minor muscles adjacent to this artery. About 10 mL of local anesthetic in this plane is sufficient for block. Larger volumes of local anesthetic may cause brachial plexus block.
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