PECS2 or PICK2

To the editor We thank Sethuraman and Narayanan for their interest in our work. We agree with them that the PECS2 block as initially described by Blanco et al, included two injection points. As highlighted by Sethuraman and Narayanan, this was often misinterpreted as one injection between the pectoralis minor and the serratus anterior muscles. The issue they raise in their letter is exactly why leaders of ASRA Pain Medicine and ESRA agreed to conduct the standardizing nomenclature project. A large international group of experts in regional anesthesia agreed that giving one name for a block that describes two injection sites was confusing. The general principle agreed on when naming any fascial plane block is to give the block a name that describes the location of the needle tip during the injection. This name should be based on the surrounding sonoanatomical landmarks. With this in mind, if someone wishes to refer to the PECS2 block as originally described, we encourage that they refer to it as two separate blocks: the interpectoral block and the pectoserratus plane block. This approach simplifies the description and makes it anatomically relevant. During the Delphi process, 69% of experts contributing to the study agreed with this approach, meaning that there was consensus, weak though it may be. We suspect that history and familiarity of practitioners with the original nomenclature (PECS1 and PECS2) are the main reason why a strong consensus was not achieved. It is worth noting that the rhomboid intercostal subserratus block was another technique that described two injection points. The same principle was followed to simplify and standardize the nomenclature. In essence, practitioners should consider that they are performing two blocks instead of one block if they are injecting in two different target locations.