Loco-regional fascial blocks in breast-conserving surgery: towards a new standard?

Breast-conserving surgery (BCS) is widely regarded as the standard treatment for early-stage breast cancer. Conventional general anesthesia is often associated with respiratory complications, postoperative nausea and vomiting (PONV), and delayed recovery. The introduction of ultrasound-guided loco-regional fascial blocks has enabled safer and more effective alternatives. A retrospective observational study was conducted at the Breast Surgery Unit of the University of Naples Federico II between January 2022 and April 2025. A total of 424 patients undergoing BCS under loco-regional anesthesia, including Serratus Anterior Plane Block (SAPB) or Branches of Intercostal Nerves at the Level of the Mid-Axillary Line (BRILMA) combined with Pectoral Nerves Block Type I (PECS I) and Pectoral Branch of the Suprascapular Nerve Block (PBS), with analgo-sedation, were analyzed. The main endpoints included postoperative pain measured by Numeric Rating Scale (NRS, 0-10), opioid consumption within 24 h (mg of intravenous morphine equivalents), incidence of PONV (%), length of hospital stay, and incidence of chronic post-operative pain at three months. Mean postoperative pain scores were 1.2 ± 0.5 (1 h), 1.5 ± 0.6 (6 h), 1.3 ± 0.5 (12 h) and 0.9 ± 0.4 (24 h). Morphine consumption averaged 2.1 ± 0.7 mg (intravenous morphine equivalents) within the first 24 h. PONV occurred in 4% of patients. Same-day discharge was achieved in 96.2% of cases, while chronic pain (NRS > 3 at 3 months) occurred in 2.6% of patients. Loco-regional anesthesia for BCS, including SAPB and BRILMA-based techniques, provides effective surgical anesthesia and postoperative analgesia, minimal opioid use, low incidence of PONV, and rapid recovery. Ultrasound-guided fascial plane blocks represent an effective and safe alternative to general anesthesia, supporting their use in selected patients.