Application of nerve blocks in breast surgery: evolution and prospects from efficacy comparison to multidimensional assessment and precision application

Postoperative pain represents a significant challenge after breast surgery, emphasizing the need for effective perioperative pain management. Guided by enhanced recovery after surgery (ERAS) principles, multimodal analgesia strategies centered on nerve block have become a prominent clinical research focus. This review comprehensively explores the evolution of nerve block techniques in breast surgery, ranging from the “gold standard” thoracic paravertebral block (TPVB) to newer thoracic fascial plane blocks, including the pectoral nerve blocks (PECS), serratus anterior plane block (SAPB), erector spinae plane block (ESPB), and other innovative approaches. It evaluates the relative benefits and limitations of various techniques regarding analgesic efficacy, opioid-sparing potential, safety, and procedural simplicity. Beyond traditional acute pain management, this review addresses the prevention of chronic post-mastectomy pain syndrome (PMPS), improvements in postoperative recovery quality, and potential effects on oncological outcomes. This review emphasizes the importance of designing individualized precision nerve block strategies based on the surgical scope (e.g., breast-conserving surgery, mastectomy, axillary lymph node dissection, and breast reconstruction) and the distinct features of each technique. No single nerve block technique fits all scenarios; clinical decision-making should focus on selecting the most appropriate approach tailored to the specific patient and procedure. Future research should prioritize high-quality trials for emerging techniques, long-term outcome evaluations, and the development of standardized nerve block protocols to enhance evidence-based practices in this domain.