Males are frequently affected by gynecomastia, a benign proliferative glandular tissue condition of the breast. Gynecomastia is usually treated with surgery to remove breast tissue. Using erector spinae plane block and thoracic segmental spinal anaesthesia in place of typical general anaesthesia during breast procedures has become more common in recent years. This case report presents the management of a 24-year-old male with long-standing left breast gynecomastia. Using a combination of erector spinae plane block and thoracic segmental spinal anaesthesia, the patient had the breast tissue excised. The regulation of the neuroendocrine stress response, lower need for analgesics after surgery, and decreased postoperative nausea and vomiting are among the many benefits of the anaesthetic methods. With better patient outcomes, fewer surgical complications, and efficient postoperative pain management, these methods offer a compelling substitute for general anaesthesia. The range of surgical scenarios in which these techniques can be applied could be expanded by additional research and clinical experience.

Aesthetic breast surgery is the most common body surgery at Bagatin Polyclinic. During 2020 and 2021, altogether 274 cosmetic surgeries were performed on the breasts. This included breast augmentation, breast augmentation and lifting operations, in a ratio of 2 to 1.According to statistics from the American Association of Plastic Surgeons (ASPS), in 2020 breast augmentation with implants was ranked fifth of all cosmetic surgeries performedand the second largest body surgery immediately after liposuction, with 193,073 procedures done. In addition to these procedures, breast augmentation (87,051) and breast reduction (33,574) procedures were also popular. Due to the increased interestin these procedures and their high daily percentage of operating programs, adequate analgesia and recovery of patients, who undergo these cosmetic breast corrections, areimportant. Today, it is no longer enough for an operation to go well and the patients to have good results. It is also important that the procedure itself, from induction of anesthesia to early and late recovery, allows for a quick return to daily activities and work.

Multidisciplinary treatment and multimodal analgesia are the approach to reduce mortality and morbidity of breast cancer. Pectoral nerve block (PECS I and II) is one of the modes of analgesia advocated. The primary aim is to find the risks and benefits of the block in providing analgesia for intraoperative and immediate postoperative cancer-related breast surgery and total morphine consumption. The secondary aim is to evaluate, any additional knowledge acquired, in the reduction of persistent chronic pain state and cancer recurrence, during the time frame studied. The study was conducted after the approval of the ethics committee and National Registry, and included patients of ASA I and II undergoing mastectomy surgery with axillary clearance, under general anesthesia, during the period of 2017 to 2018. A total of 60 patients were recruited, randomizing them into two groups: group 1 (n = 30): ultrasound-guided PECS I (0.2 ml/kg) and PECS II (0.4 ml/kg) block, post-induction with 0.25% levobupivacaine, maximum dose of 2 mg/kg; group 2 (n = 30): no block, only general anesthesia. Intraoperatively, vitals were monitored at regular intervals and analgesics given as per response. Postoperatively, pain was assessed using the numerical pain score and arm abduction score, until discharge. Data collected was analyzed and interpreted using statistical methods. Patients were followed up telephonically, until six months for any chronic pain and cancer recurrence instances. The PECS block group used less morphine intra and postoperatively, which was statistically significant (p = 0.0001). Group 1- Had a significant decrease in the mean intraoperative systolic blood pressure (p = 0.03). There was significant improvement in the arm abduction in the test group as compared to that in the control group (p = 0.001). The average time for block performance was 7.9 min and no complications were observed. No patients in the study groups reported chronic pain or cancer recurrence issues. The two-level PECS block is safe, effective, reliable, and easy to perform. Clinical Trial Registration Number: CTRI/2017/11/010630.