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Journal of Anesthesia

, Volume 30, Issue 6, pp 1074–1077 | Cite as

Clinical usefulness of pectoral nerve block for the management of zoster-associated pain: case reports and technical description

  • Yeon-Dong Kim
  • Seon-Jeong Park
  • Junho Shim
  • Hyungtae KimEmail author
Clinical Report

Abstract

The recently introduced pectoral nerve (Pecs) block is a simple alterative to the conventional thoracic paravertebral block or epidural block for breast surgery. It produces excellent analgesia and can be used to provide balanced anesthesia and as a rescue block in cases where performing a neuraxial blockade is not possible. In the thoracic region, a neuraxial blockade is often used to manage zoster-associated pain. However, this can be challenging for physicians due to the increased risk of hemodynamic instability in the upper thoracic level, and comorbid and contraindicated medical conditions such as coagulopathy. Here, we introduce an ultrasound-guided Pecs block for the management of herpes zoster-associated pain, which could be an effective alternative to other interventional options in the thoracic region.

Keywords

Herpes zoster Nerve block Pectoral nerve Thoracic nerve Ultrasound 

Notes

Acknowledgments

This work was supported by Wonkwang University 2016.

References

  1. 1.
    Blanco R, Fajardo M, Parras T. Ultra-sound description of pecs II (modified pecs I): a novel approach to breast surgery. Rev Esp Anestesiol Reanim. 2012;59:470–5.CrossRefPubMedGoogle Scholar
  2. 2.
    Jung HS, Kang JK, Yoo SH. Epidemiological study on the incidence of herpes zoster in nearby cheonan. Korean J Pain. 2015;28:193–7.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Hardy D. Relief of pain in acute herpes zoster by nerve blocks and possible prevention of post-herpetic neuralgia. Can J Anaesth. 2005;52:186–90.CrossRefPubMedGoogle Scholar
  4. 4.
    Blanco R. The ‘Pecs block’: a novel technique for providing analgesia after breast surgery. Anaesthesia 2011;66:847–8.Google Scholar
  5. 5.
    Davies F, Gladstone RJ, Stibbe EP. The anatomy of the intercostal nerves. J Anat. 1932;66:323.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Blanco R, Parras T, McDonnell JG, Prats Galino A. Serratus plane block: a novel ultrasound-guided thoracic wall nerve block. Anaesthesia. 2013;68:1107–13.CrossRefPubMedGoogle Scholar
  7. 7.
    Hadzic A. Intercostal Block. In: Hadzic A, ed. Hadzic’s Peripheral Nerve Blocks and Anatomy for Ultrasound-Guided Regional Anesthesia. USA: McGraw-Hill; 2012. P.304.Google Scholar
  8. 8.
    Moore DC. Intercostal nerve block. 1963. Int Anesthesiol Clin. 1998;36:29–41.CrossRefPubMedGoogle Scholar
  9. 9.
    Shanti CM, Carlin AM, Tyburski JG. Incidence of pneumothorax from intercostal nerve block for analgesia in rib fractures. J Trauma. 2001;51:536–9.PubMedGoogle Scholar
  10. 10.
    Kim YD, Moon HS. Review of medical dispute cases in the pain management in Korea: a medical malpractice liability insurance database study. Korean J Pain. 2015;28:254–64.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Ho AM, Karmakar MK, Critchley LA. Acute pain management of patients with multiple fractured ribs: a focus on regional techniques. Curr Opin Crit Care. 2011;17:323–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Van Veen JJ, Nokes TJ, Makris M. The risk of spinal haematoma following neuraxial anaesthesia or lumbar puncture in thrombocytopenic individuals. Br J Haematol. 2010;148:15–25.CrossRefPubMedGoogle Scholar
  13. 13.
    Roberts HR, Monroe DM, Escobar MA. Current concepts of hemostasis: implications for therapy. Anesthesiology. 2004;100:722–30.CrossRefPubMedGoogle Scholar
  14. 14.
    Warman P, Nicholls B. Ultrasound-guided nerve blocks: efficacy and safety. Best Pract Res Clin Anaesthesiol. 2009;23:313–26.CrossRefPubMedGoogle Scholar
  15. 15.
    Cox B, Durieux ME, Marcus MA. Toxicity of local anaesthetics. Best Pract Res Clin Anaesthesiol. 2003;17:111–36.CrossRefPubMedGoogle Scholar
  16. 16.
    Knudsen K, Beckman Suurküla M, Blomberg S, Sjövall J, Edvardsson N. Central nervous and cardiovascular effects of i.v. infusions of ropivacaine, bupivacaine and placebo in volunteers. Br J Anaesth. 1997;78:507–14.CrossRefPubMedGoogle Scholar
  17. 17.
    Toju K, Shiraishi K, Hakozaki T, Isosu T, Murakawa M. Plasma ropivacaine concentration following ultrasound-guided subcostal transversus abdominis plan block in adults. J Anesth. 2015;29:146–8.CrossRefPubMedGoogle Scholar

Copyright information

© Japanese Society of Anesthesiologists 2016

Authors and Affiliations

  1. 1.Department of Anesthesiology and Pain MedicineWonkwang University College of Medicine, Wonkwang Institute of ScienceIksanRepublic of Korea
  2. 2.Department of Anesthesiology and Pain MedicinePresbyterian Medical Center, Seonam University College of MedicineJeonjuRepublic of Korea

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