Combined usage of intercostal nerve block and tumescent anaesthesia: An effective anaesthesia technique for breast augmentation

Abstract

Patients are occasionally unhappy with the size, shape, and positioning of breast implants. An option to improve their satisfaction with breast augmentation includes directly involving them in the process with awake surgery done under nerve block and tumescence. This study describes the resultsof using such an awake anaesthesia technique in 35 patients. After the intercostal nerves dominating the Th3 to Th6 regions were anaesthetized using 0.5% bupivacaine, a tumescent solution consisting of lidocaine, epinephrine, and saline was injected around the mammary gland, and breast augmentation was conducted using silicon implants. The majority of patients (31/35) reported no pain during the procedure and all patients were able to choose and confirm their final implant size and positioning. In all cases, blood loss was less than 10 ml. No patient experienced pneumothorax or toxicity of local anaesthetics. Combined usage of the intercostal nerve block and tumescent anaesthesia effectively reduces pain during breast augmentation. Keeping patient conscious enables meeting their requests during operation, contributing to increased satisfaction. For these advantages, combined usage of the intercostal nerve block and tumescent anaesthesia is recommended as a useful anaesthetic technique for breast augmentation.

Thoracic Intercostal Nerve Blocks Reduce Opioid Consumption and Length of Stay in Patients Undergoing Implant-Based Breast Reconstruction

“…5 Other studies of intercostal nerve block use in breast augmentation have not reported any cases of pneumothorax. 16,25,30 In concordance with the low incidence shown in these previous studies, we encountered only one pneumothorax, which resolved spontaneously and was likely related to simultaneous port placement.…”

Estimated Maximal Safe Dosages of Tumescent Lidocaine

“… 1 , 2 TLA has been extended to a wide range of other surgical procedures involving cutaneous, subcutaneous, breast, and vascular tissues. 3 – 25 The maximum safe dosage of tumescent lidocaine for these procedures is unknown. There is a need for a pharmacokinetic-based estimate of the maximum safe milligram per kilogram dosage of tumescent lidocaine.…”

Rib fractures and nerve block. A 84 case study

“…Diclophenac also can be given in combination with nerve block with excellent result. Combined usage of intercostal nerve block and tumescent anaesthesia is an effective anaesthesia technique for breast augmentation [3].…”