Related Experiment Video
Updated: Jun 20, 2026
Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
Published on: May 17, 2024
Effectiveness of pre-incision vs. post-incision PECS II block for breast reconstruction pain: A retrospective cohort
Anshumi Desai1, Peter A Borowsky2, Maria Mantero3
1Division of Plastic and Reconstructive Surgery, DeWitt Daughtry Family Department of Surgery, United States; University of Miami Miller School of Medicine, Miami, FL, United States.
Introduction:
Pectoralis nerve block type II (PECS II) reduces postoperative pain and opioid need in breast surgery patients. Although PECS II are traditionally placed preoperatively by a specialised anaesthesiologist, we aimed to determine whether surgeon-administered post-incision PECS II is associated with similar postoperative pain and opioid need.
Methods:
This single-institution retrospective cohort study included patients who underwent mastectomy with reconstruction between January 2019 and December 2021. Patients were divided into pre- (PRE-PECS) versus post-incision (POST-PECS) PECS II groups. Primary and secondary outcomes were postoperative pain scores and opioid need (oral morphine equivalents: OMEs) during admission.
Results:
Eighty-nine patients were included: 31 (35%) PRE-PECS and 58 (65%) POST-PECS. Overall, 111 PECS blocks were given (31 unilateral and 58 bilateral). Demographic and treatment characteristics were similar between the cohorts. PRE-PECS patients reported higher median maximum pain scores during admission compared to POST-PECS patients (8 vs 7; p=0.046). Median first post-anaesthesia care unit and last recorded pain scores were similar. Mean 4-hour postoperative OME use and total admission OME use were similar between the cohorts. Multivariate analysis controlling for body mass index, cancer stage, reconstruction type, reconstruction plane, laterality, local anaesthetic, mastectomy type, axillary management and operative time showed no association between the PECS II block timing and pain scores or opioid need.
Conclusion:
POST-PECS offers similar pain control to PRE-PECS. Intraoperative blocks may be used by surgeons when preoperative blocks are not feasible owing to scheduling issues or lack of specialized anaesthesiologists.
