Medial and lateral pectoral nerve block with liposomal bupivacaine for the management of postsurgical pain after submuscular breast augmentation.

Breast augmentation is among the most popular surgical procedures performed in the world, with approximately 1,773,584 performed in 2013.1 The vast majority of these implants are placed submuscularly. Tissue expansion remains a common technique for reconstruction of a breast that has undergone surgical treatment for carcinoma. Submuscular device placement is often preferred, as this enhances soft-tissue coverage of the implant and reduces the risk of fibrous capsular contracture. Although submuscular implant placement has distinct advantages in many patients, postsurgical recovery is marked by pain related to the stretching of the pectoralis major muscle fibers and muscle spasm from the surgical trauma and stretching forces caused by the device. Surgical creation of a submuscular pocket is greatly facilitated by pectoralis major muscle relaxation. Direct paralysis by nerve block with a local anesthetic provides profound muscle flaccidity.