Combined erector spinae plane and serratus posterior superior interfascial plane blocks for comprehensive pain management in breast surgery: A potential route to pectoral nerve coverage

Abstract

Postoperative pain management in breast cancer surgery remains challenging, particularly in procedures involving submammary tissue expander placement, where patients often report inadequate pain control. The complex innervation of the breast region, involving intercostal nerves (T2–T6), brachial plexus branches, and supraclavicular nerves (C3–C4), necessitates comprehensive anaesthetic coverage. We present four cases utilising a novel combined approach of erector spinae plane (ESP) and serratus posterior superior interfascial plane (SPSIP) blocks for perioperative pain management. The technique involves ultrasound-guided administration of ropivacaine 0.25% (20 ml for each block) targeting the T3 level for ESP and the fascial plane between the second and third ribs for SPSIP. This combination provides extensive hemithoracic analgesia from C3 to T10, potentially covering both superficial and deep tissue components of surgical pain. Our cases demonstrated excellent postoperative pain control with minimal analgesic requirements. The proximity of injection sites allows efficient block performance without patient repositioning. This additive approach shows promise in achieving comprehensive analgesia for breast surgery, including cases involving tissue expanders, though larger targeted studies are needed to confirm these preliminary findings.