so with the pec block what we're trying to do is i usually take my thumb and pull the pectoralis away and i'm going just underneath the pectoralis and you can usually feel the needle just pop through in that avascular plane between the pectoralis major and pectoralis minor and then we're finding that on ultrasound we see the needle in that space and we give a little test dose of a couple of cc's of saline you can see the spread between the pec major and pec minor of that anechoic black fluid and once we've established that we're in the correct spot then the nurse switches over and we're putting in 15 cc's of rhopivocane per side so there there's a needle right in the pec major pec minor can give me a testosterone it's the spread perfect okay there we go injecting yep so now we're just going to follow the needle and you can see it opening up that plane between the pec major and the pec minor there's the medication sitting between the two muscles and the reason to use ropicane is it's inexpensive and it seems to last long enough for good pain relief with the pec block we don't see as much use of narcotic in the epac as we used to our patients probably stay 15 20 minutes now with the pec block they're not very nauseous because they're not needing opiates and i don't see the high riding implant with a necessity for massage and straps and all that craziness that people talk about we just don't see it you
