Pectoral Nerve Blocks for Breast Cancer Surgery: A Methodological Evaluation

To the Editor: We read the recent article by Bashandy and Abbas regarding Pecs I and Pecs II blocks for breast cancer procedures. Many anterior branches of intercostal nerves (Th2-6) dominate the region of the internal mammary area. Intercostal nerves transverse on the space (transversus thoracic muscle plane [TTP]) between the transversus thoracic muscles through the paravertebral space.Wewill describe a case in which the internal mammary area was blocked by injection of a local anesthetic in the TTP (TTP block). An 86-year-old woman was scheduled to undergo segmental resection at the upper outer region of her left breast. We obtained her consent for publishing her case information. A severe heart dysfunction was present (ejection fraction, 35%; Mod-Simpson method) with inferior wall motion abnormalities and mild aortic, mild mitral, and moderate tricuspid regurgitation. Considering the risks of general anesthesia and