Synergy from two different fascial blocks for multimodal analgesia in breast cancer surgery

Breast cancer surgery often results in significant postoperative pain, which can have psychological, physiological, and socio-economic consequences, and increase the risk of chronic pain. While locoregional anesthesia, including fascial blocks, has become essential in perioperative pain management, achieving adequate coverage in complex breast surgeries, especially with axillary dissection, remains challenging. This report presents a case of a 55-year-old woman undergoing left mastectomy with axillary lymph node dissection. A combination of a unilateral Erector Spinae Plane (ESP) block at the T2-T3 level and a Serratus Posterior Superior Intercostal Plane (SPSIP) block was performed preoperatively. The patient experienced minimal postoperative pain, with low pain scores (0/2) at 3, 12, and 48 hours post-surgery, requiring only one dose of paracetamol. The blocks provided effective analgesia, and the patient had no complications. The combined use of these two fascial blocks enhances coverage by targeting both intercostal and brachial plexus branches, offering a synergistic effect and the proximity of the block sites allows for efficient performance without repositioning the patient, reducing execution time. We believe the synergic combination of SPSIP and ESP blocks offers a promising strategy for pain management in breast cancer surgeries involving axillary dissection.