ArticleUpdates in surgery2026
Loco-regional fascial blocks in breast-conserving surgery: towards a new standard?
Article in Updates in surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Breast-conserving surgery (BCS) is widely regarded as the standard treatment for early-stage breast cancer. Conventional general anesthesia is often associated with respiratory complications, postoperative nausea and vomiting (PONV), and delayed recovery. The introduction of ultrasound-guided loco-regional fascial blocks has enabled safer and more effective alternatives. A retrospective observational study was conducted at the Breast Surgery Unit of the University of Naples Federico II between January 2022 and April 2025. A total of 424 patients undergoing BCS under loco-regional anesthesia, including Serratus Anterior Plane Block (SAPB) or Branches of Intercostal Nerves at the Level of the Mid-Axillary Line (BRILMA) combined with Pectoral Nerves Block Type I (PECS I) and Pectoral Branch of the Suprascapular Nerve Block (PBS), with analgo-sedation, were analyzed. The main endpoints included postoperative pain measured by Numeric Rating Scale (NRS, 0-10), opioid consumption within 24 h (mg of intravenous morphine equivalents), incidence of PONV (%), length of hospital stay, and incidence of chronic post-operative pain at three months. Mean postoperative pain scores were 1.2 ± 0.5 (1 h), 1.5 ± 0.6 (6 h), 1.3 ± 0.5 (12 h) and 0.9 ± 0.4 (24 h). Morphine consumption averaged 2.1 ± 0.7 mg (intravenous morphine equivalents) within the first 24 h. PONV occurred in 4% of patients. Same-day discharge was achieved in 96.2% of cases, while chronic pain (NRS > 3 at 3 months) occurred in 2.6% of patients. Loco-regional anesthesia for BCS, including SAPB and BRILMA-based techniques, provides effective surgical anesthesia and postoperative analgesia, minimal opioid use, low incidence of PONV, and rapid recovery. Ultrasound-guided fascial plane blocks represent an effective and safe alternative to general anesthesia, supporting their use in selected patients.
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