Intercostal nerve block of the anterior cutaneous branches and the sensibility of the female breast

Bijkerk, Ennie; Cornelissen, Anouk J. M.; Sommer, Michael; Hulst, René R W J van der; Lataster, Arno; Tuinder, Stefania

doi:10.1002/ca.23532

Cited by 18 publications

(11 citation statements)

References 32 publications

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“…This indicates that the nerve coaptation was effective. The area pointed out by the patients when the flap skin was stimulated corresponds to the areas innervated by the ACBs of the 2nd and 3rd ICN [26]. We hypothesize that the recipient nerve, instead of the donor nerve, is responsible for where sensation is experienced by the patient.…”

Section: Discussionmentioning

confidence: 94%

Breast sensibility in bilateral autologous breast reconstruction with unilateral sensory nerve coaptation

Bijkerk

Kuijk

Lataster

et al. 2020

Breast Cancer Res Treat

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Background Patient satisfaction after breast reconstruction is dependent on both esthetics and functional outcomes. In an attempt to improve breast sensibility, a sensory nerve coaptation can be performed. The aim of this study was to objectify the sensory recovery in patients who, by chance, underwent bilateral autologous breast reconstruction with one innervated and one non-innervated flap. It must be emphasized that the intention was to coaptate the sensory nerves on both sides. Methods The cohort study was carried out in the Maastricht University Medical Center between August 2016 and August 2018. Patients were eligible if they underwent bilateral non-complex, autologous breast reconstruction with unilateral sensory nerve coaptation and underwent sensory measurements using Semmes-Weinstein monofilaments at 12 months of follow-up. Sensory outcomes were compared using t tests. Results A total of 15 patients were included, all contributing one innervated and one non-innervated flap. All patients had a follow-up of at least 12 months, but were measured at different follow-up points with a mean follow-up of 19 months. Sensory nerve coaptation was significantly associated with better sensation in the innervated breasts and showed better sensory recovery over time, compared to non-innervated breasts. Moreover, the protective sensation of the skin can be restored by sensory nerve coaptation. Conclusions The study demonstrated that sensory nerve coaptation leads to better sensation in the autologous reconstructed breast in patients who underwent bilateral breast reconstruction and, by chance, received unilateral sensory nerve coaptation.

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Section: Discussionmentioning

confidence: 94%

Breast sensibility in bilateral autologous breast reconstruction with unilateral sensory nerve coaptation

Bijkerk

Kuijk

Lataster

et al. 2020

Breast Cancer Res Treat

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“…2). 13 Five studies (16 percent) reported on intercostal nerve blocks in both reconstructive and aesthetic breast plastic surgery procedures; 357 patients received intercostal nerve blocks, while 118 served as controls. Procedures examined included prosthetic reconstruction ( n = 1 study, 20 percent), and aesthetic breast plastic surgery procedures ( n = 4 studies, 80 percent).…”

Section: Resultsmentioning

confidence: 99%

“…2). 13 Five studies (16 percent) reported on intercostal nerve blocks in both reconstructive and aesthetic breast plastic surgery procedures; 357 patients received…”

Section: Intercostal Nerve Blocksmentioning

confidence: 99%

Nerve Blocks in Breast Plastic Surgery: Outcomes, Complications, and Comparative Efficacy

Abi‐Rafeh

Safran

Abi-Jaoude

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Background: As plastic surgeons continue to evaluate the utility of nonopioid analgesic alternatives, nerve block use in breast plastic surgery remains limited and unstandardized, with no syntheses of the available evidence to guide consensus on optimal approach. Methods: A systematic review was performed to evaluate the role of pectoralis nerve blocks, paravertebral nerve blocks, transversus abdominus plane blocks, and intercostal nerve blocks in flap-based breast reconstruction, prosthetic-based reconstruction, and aesthetic breast plastic surgery, independently. Results: Thirty-one articles reporting on a total of 2820 patients were included in the final analysis; 1500 patients (53 percent) received nerve blocks, and 1320 (47 percent) served as controls. Outcomes and complications were stratified according to procedures performed, blocks employed, techniques of administration, and anesthetic agents used. Overall, statistically significant reductions in opioid consumption were reported in 91 percent of studies evaluated, postoperative pain in 68 percent, postanesthesia care unit stay in 67 percent, postoperative nausea and vomiting in 53 percent, and duration of hospitalization in 50 percent. Nerve blocks did not significantly alter surgery and/or anesthesia time in 83 percent of studies assessed, whereas the overall, pooled complication rate was 1.6 percent. Conclusions: Transversus abdominus plane blocks provided excellent outcomes in autologous breast reconstruction, whereas both paravertebral nerve blocks and pectoralis nerve blocks demonstrated notable efficacy and versatility in an array of reconstructive and aesthetic procedures. Ultrasound guidance may minimize block-related complications, whereas the efficacy of adjunctive postoperative infusions was proven to be limited. As newer anesthetic agents and adjuvants continue to emerge, nerve blocks are set to represent essential components of the multimodal analgesic approach in breast plastic surgery.

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“…The duration of the herein presented anaesthetic procedures compare well with spinal anaesthesia, for example, estimated to take 30–40 min [ 39 ]. Anatomical studies have confirmed that blockage of all levels 2–5 partially affected sensation in the nipple-areola complex, suggesting innervation by a nerve plexus consisting of both anterior cutaneous branches and lateral cutaneous branches [ 40 ]. The added value of parasternal blocks when using intercostal blocks remains unclear.…”

Section: Discussionmentioning

confidence: 99%

Enhanced Recovery After Aesthetic Breast Surgery Under Sedation, Intercostal Block and Tumescent Anaesthesia: A Prospective Cohort Study of the Early Postoperative Phase

Stahl¹,

Stahl²,

Feng

et al. 2022

Aesth Plast Surg

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Background Comfort and recovery are major concerns of patients seeking aesthetic surgery. This study aimed to assess postoperative pain and recovery after outpatient breast surgery under sedation, intercostal block, and local anaesthesia. Methods This prospective cohort study included all consecutive patients who underwent aesthetic breast surgery between April 2021 and August 2022. Epidemiological data, anaesthesia, pain, and patients’ satisfaction were systematically assessed with standardized self-assessment questionnaires. Results Altogether, 48 patients [median (IQR) age: 30 (36–25)] were included. The most frequent surgery was mastopexy. 69% of surgeries involved additional procedures. The mean intercostal block and local anaesthesia time was 15 min. Patients received a median (IQR) of 19 (34–2) mg/kg lidocaine and 2.3 (2.5–2.0) mg/kg ropivacaine. The median (IQR) consumption of propofol and alfentanil was, respectively, 4.89 (5.48–4.26) mg/kg/h and 0.27 (0.39–0.19) µg/kg/min. No conversion to general anaesthesia or unplanned hospital admission occurred. Patients were discharged after a median (IQR) of 2:40 (3:43–1:58) hours. Within the first 24 postoperative hours, 17% required once an antiemetic medication and 38% an opioid. Patients were very satisfied with the anaesthesia and 90% of the patients had not wished more analgesia in the first 24 h. Conclusions Aesthetic breast surgery under sedation, intercostal block, and tumescent anaesthesia can safely be performed as an ambulatory procedure and is associated with minimal intra- and postoperative opioid consumption and high patient satisfaction. These data may be used to inform patients and clinicians and improve the overall quality of care. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . Supplementary Information The online version contains supplementary material available at 10.1007/s00266-022-03214-w.

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Intercostal nerve block of the anterior cutaneous branches and the sensibility of the female breast

Cited by 18 publications

References 32 publications

Breast sensibility in bilateral autologous breast reconstruction with unilateral sensory nerve coaptation

Breast sensibility in bilateral autologous breast reconstruction with unilateral sensory nerve coaptation

Nerve Blocks in Breast Plastic Surgery: Outcomes, Complications, and Comparative Efficacy

Enhanced Recovery After Aesthetic Breast Surgery Under Sedation, Intercostal Block and Tumescent Anaesthesia: A Prospective Cohort Study of the Early Postoperative Phase

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