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.

This article focuses on a novel combined regional anaesthesia technique using erector spinae plane (ESP) and serratus posterior superior interfascial plane (SPSIP) blocks for postoperative pain management in breast cancer surgeries involving submammary tissue expander placement. The combined blocks, administered under ultrasound guidance at the T3 vertebral level and between the second and third ribs, aim to provide extensive hemithoracic analgesia from cervical (C3) to thoracic (T10) dermatomes, potentially covering both superficial and deep musculoskeletal pain components. A case series of four patients demonstrated effective postoperative pain control with minimal analgesic requirements and practical advantages such as no need for patient repositioning during block administration. While the involvement of pectoral nerves remains theoretical and requires further anatomical validation, this combined approach shows promise for comprehensive analgesia in breast surgery, warranting larger studies to confirm efficacy and safety.