I read the recently published article on pectoral nerve blocks (PECS) for breast augmentation procedures with immense interest.  I greatly appreciate the authors for analyzing the efficacy of PECS blocks on breast augmentation procedures and congratulate them for publishing this wonderful study on this topic that has only a few studies in the literature. I wish to present my reflections on it.

Aarab et al. mentioned that theirs is the first study to provide PECS blocks after general anesthesia but before surgery, thereby facilitating sensory block during surgery itself. However, to my knowledge, there are few more studies that have provided PECS blocks before the commencement of surgical procedure (breast augmentation). For instance, in a recently published study by Schuitemaker et al.  surgery of the first breast (right-side) was started 20 min after the completion of PECS block plus serratus plane block. In another recently published study also  the PECS I block was advocated before surgery. Indeed, Desroches et al.3  performed the PECS I block before the induction of general anesthesia itself. In addition, they found that PECS I block is not superior to sham block for providing postoperative pain relief when the patients were made their own control too for one side versus the other side.  In contrast to these studies, a study released in December 2020 by Ciftci et al.  compared the preoperative versus postoperative administration of PECS I block in breast augmentation and concluded that preoperative PECS I was superior to postoperative PECS I and the control group. Furthermore, PECS blocks were performed either preoperatively or intraoperatively (after induction of general anesthesia but before surgery) in many studies according to a meta-analysis by Hussain et al.  involving various breast cancer procedures.

Aarab et al.  used the phrase “combined PECS I and PECS II blocks,” which is incorrect because PECS II block includes both PECS I (a pectoral component; i.e., injection between pectoralis major and minor) and an additional component (subpectoral component; i.e., injection between pectoralis minor and serratus anterior).