• Mohammad M Piracha, Stephen L Thorp, Vinay Puttanniah, and Amitabh Gulati.
• From the *Department of Anesthesiology, Weill Medical College of Cornell University and New York Presbyterian Hospital; and †Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, NY.
• Reg Anesth Pain Med. 2017 Mar 1; 42 (2): 259-262.

IntroductionPostmastectomy pain syndrome (PMPS) is a significant burden for breast cancer survivors. Although multiple therapies have been described, an evolving field of serratus anterior plane blocks has been described in this population. We describe the addition of the deep serratus anterior plane block (DSPB) for PMPS.MethodsFour patients with history of PMPS underwent DSPB for anterior chest wall pain. A retrospective review of these patients' outcomes was obtained through postprocedure interviews.ResultsThree of the patients previously had a superficial serratus anterior plane block, which was not as efficacious as the DSPB. The fourth patient had a superficial serratus anterior plane that was difficult to separate with hydrodissection but had improved pain control with a DSPB.ConclusionsWe illustrate 4 patients who have benefitted from a DSPB and describe indications that this block may be more efficacious than a superficial serratus plane block. Further study is recommended to understand the intercostal nerve branches within the lateral and anterior muscular chest wall planes.

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