Intercostobrachial Nerve (ICBN) Preservation Versus Sacrifice in Axillary Dissection

Abstract

Objectives: Whether to preserve or sacrifice the intercostobrachial nerves (ICBN) is a controversial issue. In this trial, we aim to assess the effects of preservation of the ICBN during axillary dissection for patients with breast cancer in terms of pain score immediately postoperatively and several hours later, need for simple analgesia and narcotics, numbness and arm swelling.Materials and Methods: This is a single-institution, single-surgeon randomized controlled trial where a sample of 48 patients with breast cancer, of various age groups, were allocated randomly to any of the 2; preservation or sacrifice categories. Postoperatively, patients were asked by a physician to fill a predesigned questionnaire to assess the studied items during hospitalization and after discharge.Results: Among the 48 included patients, ICBN was sacrificed in 24 patients; of which 18 patients (75%) developed numbness in the inner aspect of the arm. While in the ICBN preservation group (24 patients) only 6 patients suffered numbness (25%) with a significant P-value of 0.001. Estimated duration of surgery with ICBN preservation was 100 22.02 minutes, while it is significantly shorter in the ICBN sacrifice group (83.48 21.55). However, with regard to other variables of pain, seroma formation, need of simple analgesia and narcotics, hospital admission days and arm swelling, there was no significant difference between the 2 groups. Conclusion:This study can conclude that preservation of ICBN during axillary dissection in patients with breast CA can save these patients' additional suffering from inner arm numbness. That is at the expense of surgery duration, around 20 minutes longer, for the surgeon to take his/ her time in carefully dissecting the axilla properly without injuring these ICBN.

Anatomical variants of the intercostobrachial nerve and its preservation during surgery, a systematic review and meta-analysis

“…The systematic review and meta-analysis include twenty-three studies published between 1999 and 2023. Six studies were conducted on cadaveric samples [ 9 , 15 , 16 , 23 , 27 , 28 ], and seventeen were performed intraoperatively [ 2 – 4 , 6 , 10 – 14 , 17 – 22 , 24 – 26 ]. The studies exhibit a broad geographic distribution, with 10 studies from Asia [ 3 , 4 , 9 – 12 , 16 , 18 , 21 , 28 ], 6 from Europe [ 6 , 14 , 19 , 20 , 25 , 26 ], 4 from South America [ 2 , 15 , 22 , 24 ], and one each from North America [ 23 ], Africa [ 17 ], and Australia [ 27 ].…”

Intercostobrachial neuralgia—a case of bizzare diagnosis?

“…The reproduction of medial arm symptoms with palpatory exam to the second and third rib angle can be an indicator of this diagnosis. The history of the upper thoracic rib cage or axillary lymph node surgery can directly affect the intercostobrachial nerve via trauma or indirectly by affecting the arthrokinematics and biomechanics of the upper rib cage [20]. Entrapment of the intercostobrachial nerve affected by indirect factors can be managed by addressing soft tissue restrictions in the pectoral region and by restoring the arthrokinematics of the second and third costovertebral and costotransverse joint.…”

Altered somatosensory functioning and mechanism‐based classification in breast cancer patients with persistent pain

“…Signs and symptoms reported are burning pain, shooting pain, pressure sensation, and/or numbness (incidence and risks, 2012). The contribution of the resected intercostobrachial nerve (ICBN) with axillary lymph node dissection resulting in hypoesthesia/anesthesia together with static mechanical allodynia or persistent pain has been evaluated multiple times in surgical studies for breast cancer (Ahmed et al, 2014; Andersen et al, 2014; Melhem et al, 2021; Mustonen et al, 2019; Zhu et al, 2014). A recent systematic review by Dams et al (2021) concluded that BCS with persistent pain in the surgical area showed local disturbances in thermal detection and increased TS of pain.…”