this is what i'm calling the lateral approach pectoralis block or the lap block lap originally it was described in 2015 by blanca who is a spaniard as coming over the clavicle and then going towards the chest wall through the pec major between the pec major and the pec minor i never really liked that because i was going towards the rib and so i decided to start doing this from the lateral approach and from going underneath the pectoralis major putting the needle directly in the space and on the ultrasound i'm i've got this set up on musculoskeletal i've got it set up on three centimeters so that the cleft between the pec major and the pec minor where i'm going to put this needle is directly in the middle of the screen and then i see my little impression that i've made of where the angulation is that i want to go and this is an in-plane technique so put this with my right hand we have saline in this i'm going to put this just below the pectoralis muscle and i'm looking at it on the screen a little high i just popped in i could feel it so there's my needle okay give me a testosterone aspirate back and then test those and what we want to see is that space developed between the pec major and the pec minor okay test dose again okay good switch over so you see my needle sitting right in that space right there and now she's just going to switch over to the bropivocane and this is going to dissect the space and see that advance of the fluid and i'm just following the needle forward and it's dissecting that space between the pec major and the pec minor and that's 15 cc is a real pivoting and that's the entire block and we'll do the same thing on the other side okay okay so now we're on the opposite side i'm going just in the space below the pec major and i'm trying to find the needle and i can just i felt it pop in and it's an in-plane technique so i want to be parallel go ahead give me a test hose i see the needle sitting right in the space and we should see a little black space develop and see the needle right in between the pec major and the pec minor and now we're going to switch over and put 15 cc's of rope pivot pivocaine and there's the space just opening up between the pec major and the pec minor i'm just following it along i'm trying to get all the way to the thoracoacromial which the lateral pectoral nerve runs with and that's 15 cc's okay so it's done
