From the Research
For a continuous pectoral nerve (PEC) 2 block, the recommended dosage of ropivacaine is typically a bolus of 20 mL of 0.2% ropivacaine followed by a continuous infusion of 0.1% ropivacaine at 5-8 mL/hour. This dosage is based on the most recent and highest quality study available, which compared the efficacy and safety of different local anesthetic techniques for breast surgery 1. The initial bolus provides immediate analgesia, while the continuous infusion maintains pain relief.
When placing the catheter, ensure proper positioning between the pectoralis minor and serratus anterior muscles under ultrasound guidance. The maximum daily dose of ropivacaine should not exceed 3 mg/kg to avoid local anesthetic systemic toxicity. This regional anesthesia technique is effective for breast and anterior chest wall surgeries as it blocks the lateral and anterior branches of the intercostal nerves, providing analgesia to the anterior chest wall.
Some key points to consider when administering a continuous PEC 2 block include:
- The use of ropivacaine as the local anesthetic of choice due to its long-acting properties and relatively low toxicity profile 2, 3
- The importance of monitoring patients for signs of catheter migration, infection at the insertion site, or symptoms of local anesthetic toxicity such as perioral numbness, metallic taste, or neurological changes
- The potential benefits of combining a continuous PEC 2 block with other analgesic techniques, such as local anesthetic infiltration, to optimize pain management 4, 1
- The need to individualize the dosage and administration of ropivacaine based on patient-specific factors, such as weight and medical history 5