A Novel Ultrasound-Guided Block: A Promising Alternative for Breast Analgesia

Torre, P. Alfaro de la; García, P. Diéguez; Álvarez, S. López; Miguel, Francisco Javier García; Pérez, Mario Fajardo

doi:10.1177/1090820x13515902

Cited by 98 publications

(64 citation statements)

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“…Thus, combinations of blocks are necessary to provide complete analgesia for many surgical procedures. 59 With a sophisticated understanding of the anatomy relevant to breast surgery and analgesia, combinations of various blocks will likely provide postoperative analgesia and even surgical anesthesia for a wide variety of operations (Fig. 8).…”

Section: Brachial Plexus and Novel Peripheral Nerve Blocksmentioning

confidence: 99%

Perioperative Breast Analgesia

Woodworth

Ivie

Nelson

et al. 2017

Regional Anesthesia and Pain Medicine

272

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Breast surgery is exceedingly common and may result in significant acute as well as chronic pain. Numerous options exist for the control of perioperative breast pain, including several newly described regional anesthesia techniques, but anesthesiologists have an insufficient understanding of the anatomy of the breast, the anatomic structures disrupted by the various breast surgeries, and the theoretical and experimental evidence supporting the use of the various analgesic options. In this article, we review the anatomy of the breast, common breast surgeries and their potential anatomic sources of pain, and analgesic techniques for managing perioperative pain. We performed a systematic review of the evidence for these analgesic techniques, including intercostal block, epidural administration, paravertebral block, brachial plexus block, and novel peripheral nerve blocks.

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Section: Brachial Plexus and Novel Peripheral Nerve Blocksmentioning

confidence: 99%

Perioperative Breast Analgesia

Woodworth

Ivie

Nelson

et al. 2017

Regional Anesthesia and Pain Medicine

272

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show abstract

“…9 Indeed, effective analgesia, along with theoretical technical advantages, has been reported with each of these 2 block techniques for a variety of chest wall and thoracic surgeries. [1][2][3][4][5]8,[10][11][12][13][14][15] Our use of the superficial serratus plane block has posed several practical concerns to the breast oncologic surgeons, including (i) spread into the axilla, thus disrupting the surgical tissue planes; (ii) block of the long thoracic and thoracodorsal nerves, 8 thus interfering with surgeons' effort to identify these nerves (tweaking by forceps) 16 to preserve them; and (iii) needling through potentially metastatic lymph nodes, theoretically increasing the risk of tumor seeding. [17][18][19] By contrast, the deep serratus plane block performed more posteriorly, along the posterior axillary line, seems to mitigate these concerns.…”

mentioning

confidence: 99%

Too Deep or Not Too Deep?

Abdallah

Cil

MacLean

et al. 2018

Regional Anesthesia and Pain Medicine

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“…This is a variation in the Pecs 2 block, and the needle is targeted to a more caudal and lateral position, in the mid axillary line at the level of the fifth rib, which is overlain by the serratus anterior and latissimus dorsi muscles. This blocks the lateral cutaneous branches of the intercostal nerve and the long thoracic and thoracodorsal nerves [31,32].…”

Section: Clinical Background and Anatomymentioning

confidence: 99%

“…However, these blocks are unable to anesthetize the anterior cutaneous branches of the intercostal nerves; therefore, the medial aspect of the breast including the nipple and areola are not blocked [24]. To additionally block the anterior cutaneous branches, the pectointercostal and transversus thoracic muscle plane blocks have recently been described [32][33][34]. However, further studies will be required to confirm the extent of LA spread and analgesia.…”

Section: Evidence and Clinical Applicationsmentioning

confidence: 99%

Ultrasound-guided truncal blocks for perioperative analgesia

Koh

Lee

2018

Anesth Pain Med

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Since the widespread introduction of ultrasound for assisting techniques used in anesthetic theatres, peripheral nerve blocks of the trunk have been used more frequently to produce analgesia and anesthesia for surgeries involving the thorax, abdomen, and lower extremities. The introduction of real-time ultrasound has allowed the peripheral nerves, planes, and plexuses of the trunk to be located more accurately and has improved the success rate of truncal blocks The widespread application of ultrasound in clinical anesthesiology has led to an increase in the number of practitioners performing peripheral nerve blocks of the trunk to produce analgesia and anesthesia for surgeries involving the thorax, abdomen, and lower extremities. The use of real-time ultrasound has allowed the peripheral nerves, planes, and plexuses of the trunk to be located more accurately and has improved the success rate of blocks. Compared to central neuraxial techniques, many types of truncal blocks are relatively easy to perform and have low side effect profiles. As a result, truncal blocks have been introduced to provide perioperative analgesia for surgeries involving the thorax and abdomen. The most frequently used truncal block techniques include the paravertebral block, intercostal block, pectoralis and serratus anterior block, rectus sheath block, transversus abdominis plane block, and ilioinguinal and iliohypogastric nerve blocks. Recently introduced techniques also include the quadratus lumborum and erector spinae plane blocks. To apply each block correctly and reduce the likelihood of related side effects and complications, the practitioner must have a thorough understanding of the anatomical region, optimal block positioning, and device selection and management.

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A Novel Ultrasound-Guided Block: A Promising Alternative for Breast Analgesia

Cited by 98 publications

References 1 publication

Perioperative Breast Analgesia

Perioperative Breast Analgesia

Too Deep or Not Too Deep?

Ultrasound-guided truncal blocks for perioperative analgesia

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