Ultrasound-assisted approach to blocking the intercostal nerves in the mid-axillary line for non-reconstructive breast and axilla surgery

• Published in: Revista española de anestesiología y reanimación Vol. 60; no. 7; p. 365
• Main Authors: Diéguez García, P, Fajardo Pérez, M, López Álvarez, S, Alfaro de la Torre, P, Pensado Castiñeiras, A P
• Format: Journal Article
• Language: Spanish
• Published: Spain 01.08.2013
• Subjects: Adolescent; Adult; Aged; Analgesia - methods; Axilla - diagnostic imaging; Axilla - surgery; Breast - surgery; Breast Neoplasms - surgery; Coloring Agents; Female; Humans; Intercostal Nerves - diagnostic imaging; Intercostal Nerves - drug effects; Lymph Node Excision - methods; Lymphatic Metastasis; Mastectomy - methods; Methylene Blue; Middle Aged; Nerve Block - methods; Pain, Postoperative - prevention & control; Prospective Studies; Ultrasonography, Interventional; Ultrasonography, Mammary - methods; Young Adult; Nerve block; Regional anesthesia; Bloqueo nervioso; Nervios intercostales; Segmental mastectomy; Anestesia regional; Intercostal nerves; Mastectomía segmentaria
• ISSN: 2340-3284
• DOI: 10.1016/j.redar.2013.04.002

Several nerve blocks have recently been used for pain treatment in breast surgery. The main objective of our study was to determine the efficacy and safety of ultrasound-assisted blocking of the anterior and lateral cutaneous branches of the intercostal nerves in the mid-axillary line for non-reconstructive breast and axilla surgery. A prospective observational study was conducted on 30 patients scheduled for non-reconstructive breast and axilla surgery. An intercostal branches block was performed in the mid-axillary line with 0,5% levobupivacaine (3ml in each intercostal space). Clinical efficacy was assessed by standard intraoperative hemodynamic response to surgical stimulus and the need for opioids, and in the postoperative period, by assessing pain intensity as a verbal numerical scale and the need for rescue treatment. We also evaluated the quality of sleep the first night after surgery, any adverse events that occurred, and the satisfaction of patients and surgeons with the anesthetic technique. The intercostal branches block in the mid-axillary line was effective in most cases, with only 2 patients requiring intraoperative opioids, and in one case analgesic rescue was necessary in the postoperative period. The duration of postoperative analgesia was 19±4h. There were no notable adverse events or complications. The satisfaction with the chosen technique was assessed as "very good" in all patients, and by 97% of the surgeons. Intercostal branches block in the mid-axillary line provides adequate intraoperative and postoperative analgesia for non-reconstructive breast and axilla surgery. It is a simple, reproducible technique in most patients of this study, with an easy to understand ultrasound anatomy, in which adequate analgesia could be provided through a single puncture, and may be an alternative to neuroaxial blocks.