Anatomical considerations in Pecs blocks

[...]these two nerves carry nociceptive, proprioceptive and postganglionic fibers despite being termed as motor nerves [3]. Because of these factors, we have started injecting a subcutaneous infiltration of LA in the para-sternal area following administration of Pecs II block in our day-to-day practice. [2] had no pain over the surgical area (breast) despite lack of spread of LA between PM and Pm and on the contrary, reported a pain score of 3–4/10 in the axillary area, where probably no surgical incision would have been made as this was a conservative surgery. [...]we recommend the subcutaneous infiltration of LA (5 to 8 ml) in the para-sternal area as well as adding an intercostobrachial nerve block at high axillary region (1 to 3 ml of LA) following Pecs II block (30 ml of LA).We hope that these additional measures would provide adequate sensory block to almost all the areas of breast surgery and decrease the failure rates (albeit not directly attributable to pecs block per se) substantially.Financial disclosures None.Author's contribution Raghuraman M.S. Conceptualization, Writing - Original draft preparation, Critical Reviewing and Editing.