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Background and Aims RA for breast surgery has traditionally provided partial analgesia. Variability in RA techniques has resulted in inconsistent data on post-surgery pain. PVB often fails to provide adequate analgesia for modified radical mastectomies due to its limited coverage of intercostal nerves. Newer thoracic plane blocks, which target both intercostal and brachial plexus branches, require a combination of blocks for complete pain relief. This study presents cases of post-operative breast analgesia, emphasizing the importance of considering innervation for postoperative pain management.

Methods Reports of 2 cases is exempt from our Institutional Review. The first case involves a patient undergoing mammoplasty. Bilateral serratus and parasternal plane blocks were initially performed. Upon experiencing medial breast pain postoperatively, bilateral subcostal TAP blocks were added resulting in complete pain relief. The second case involves a patient undergoing left mastectomy and right mastopexy. Serratus and external oblique blocks were performed. Postoperatively, the patient reported no pain and required no additional analgesics.

Results The appropriate combination of fascial plane blocks, tailored to surgical sites, provided complete analgesia in both cases. Extensive experience with RA for breast surgery has given us the ability to provide a regimen where patients reported no pain and required no opioids postoperatively.

Conclusions Achieving complete analgesia for breast surgery is possible with tailored RA techniques. Preoperative discussions with surgeons to determine necessary nerve blocks is crucial. Standardized RA protocols in randomized, controlled trials may not reflect clinical practice, and future prospective trials are needed to identify the optimal RA combinations for different breast surgeries.