{
  "abstract": "Background and Aims Paravertebral block (PVB) is the gold standard regional technique for breast surgery but due to proximity of the pleura and neuroaxis, can be challenging to perform. Fascial plane blocks are potentially safer alternatives. We describe incidence of pneumothorax for patients who received PVB, PECS-1, serratus, and erector spinae blocks for mastectomy.Methods After institutional review board approval was granted for this retrospective analysis, we identified 6334 mastectomies with 9290 individual blocks, between 1/5/2016 - 5/30/2024. 61% of cases were bilateral; 54% had one block type, most commonly PVB. Most common combination blocks were serratus plus PECS-1 and PVB plus PECS-1. We calculated risk of pneumothorax for all cases, all blocks as well as for laterality and block type. All blocks were placed with ultrasound-guidance by an experienced anesthesiologist or supervised trainee.Results There were four cases of pneumothorax ( table 1). Two were diagnosed shortly after the block resulting in surgery cancellation (one after PVB, one after serratus). Incidence for all cases was 0.06% (CI 0.02%, 0.16%); for individual block types, 0.04% (CI 0.01%, 0.11%). For unilateral cases, incidence was 0.04% (CI 0.001%, 0.22%); for bilateral cases, 0.08% (CI 0.02%, 0.23%). Three cases occurred after PVB, 0.07% (CI 0.01%, 0.20%); one after serratus, 0.05% (CI 0.001%, 0.30%).Abstract EP034 Table 1Breast surgery cases with preoperative chest wall block and the prevalence of pneumothoraxConclusions Incidence of pneumothorax in our cohort was rare. Only 2 cases in >9000 blocks were attributable to the block itself; the remaining 2 cases were identified after discharge with unclear etiology (nerve block versus surgery). We confirmed pneumothorax risk in a high-volume practice is extremely low and comparable between PVB and fascial plane blocks.",
  "authors": [
    {
      "affiliations": [
        "Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, USA"
      ],
      "name": "Hanae Tokita"
    },
    {
      "affiliations": [
        "Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, USA"
      ],
      "name": "Joanna Serafin"
    },
    {
      "affiliations": [
        "Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, USA"
      ],
      "name": "Kay See Tan"
    }
  ],
  "title": "EP034 Incidence of pneumothorax after preoperative chest wall blocks in ambulatory breast cancer surgery",
  "uid": "b1cbd3a7-6613-5535-896e-68e1f44a66fd"
}