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A generally well 82-year old man presented to a general surgical outpatient clinic with a swelling of the medial aspect of his left thigh. It started as a small lump which grew quickly over a few weeks to approximately 6 cm. There was no history of trauma or thromboembolic complication and the patient was asymptomatic. On examination, there was a firm round swelling which was non-tender and non-pulsatile. It did not seem to be attached to deeper structures and was not anatomically related to the nervous system. The patient was reviewed by a consultant – the diagnosis of a chronic sebaceous cyst was considered and he was offered an excision biopsy under local anaesthetic. Postoperatively, the patient had an unremarkable recovery but presented with a localized haematoma (Figure 1) on routine follow up, which was managed conservatively. Histology revealed the mass was in fact a venous aneurysm of the long saphenous vein.

BackgroundPost operative analgesia is often underestimated in breast surgery resulting in long term sequelae. Opiates and epidural analgesia may produce complications and limits early rehabilitation. We compare the effects of intercostal nerve block with subcutaneous infiltration as post operative analgesia in breast surgery.MethodsAll patients who undergo breast surgery were assigned to two groups. They either receive intercostal nerve block or subcutaneous infiltration of 0.5% bupivacaine at the end of surgery. Pain score using visual analogue scale and the total amount of morphine consumption were recorded. Personnel taking measurements were kept blind.ResultsThere were 70 patients included in the study. Of these, three patients (two from Group A and one from Group B) were excluded because of post operative haematoma and drain related complications. 33 patients had intercostal nerve block and 34 patients received subcutaneous infiltration. The groups were comparable with respect to age and type of breast surgery. There were significant differences in the visual analogue pain scores at the early post operative period in the study group (P value of < 0.05).Table 1Pain ScoreGroup A Median (range)Group B Median (range)No. of patientsP valueWith in 4 hr of surgery2 (1-8)2 (1-9)330.7521st post op 8am2 (1-6)3 (1-8)330.0091st post op 6pm2 (1-6)2 (1-10)330.0112nd post op 8am1 (1-5)2 (1-8)120.2442nd post op 6pm1 (1-4)1.5 (1-5)110.2213rd post op 8am1 (1-4)1 (1-6)90.1373rd post op 6pm1 (1-7)2 (1-4)90.347 ConclusionsWe have demonstrated in our study that intercostal nerve block provides effective post operative analgesia in breast surgery patients. The accessibility of intercostal nerves in the operative field makes blockade feasible. Contrary to the misconception, incidence of pneumothorax is very rare. It should therefore be used more widely in view of its simplicity. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5052.