New approach for blocking intercostobrachial and medial brachial cutaneous nerve in the axillary area: response to Varela

Altınpulluk, Ece Yamak; Galluccio, Felice; Salazar, Carlos; Simón, Diego García; Espinoza, Karla; Olea, Marilina Susana; Pérez, Mario Fajardo

doi:10.1136/rapm-2020-101317

Cited by 4 publications

(2 citation statements)

References 4 publications

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“…Techniques for ICBN block have been described at the level of the axilla and more proximally at the second intercostal space. [20][21][22] Taking into consideration that the nerve may be injured anywhere from its origin to the terminal branches, the proximal approach is our preferred technique, performed in close proximity to ICBN emergence from the thoracic wall at the second intercostal space (Figure 1).…”

Section: Techniquementioning

confidence: 99%

Ultrasound‐guided fascial plane blocks for post‐breast surgery pain syndrome

Ferreira‐Silva,

Hurdle,

Clendenen

et al. 2024

Pain Practice

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IntroductionPersistent pain following breast surgery is common and may be challenging to treat. In patients refractory to conservative treatments, ultrasound‐guided fascial plane blocks of thoracic nerves can be a useful option.ResultsThis type of neuro blockade technique provides advantages in terms of safety and efficacy that are convenient for physicians managing refractory and complex cases of post‐breast surgery syndrome.ConclusionThis technical review aims to present an up‐to‐date summary of the most common ultrasound‐guided fascial plane blocks for chronic pain in post‐breast surgery patients, provide a detailed technical description of each intervention, and propose preferred injections based on the anatomical location of the pain.

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Section: Techniquementioning

confidence: 99%

Ultrasound‐guided fascial plane blocks for post‐breast surgery pain syndrome

Ferreira‐Silva,

Hurdle,

Clendenen

et al. 2024

Pain Practice

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“…Therefore, the axillary block of the brachial plexus can be one of the most suitable block methods for this plexus. By performing axillary block of the brachial plexus, the inner part of the arm is not completely anesthetized because this part of the arm is innervated by the lateral cutaneous branch of the second intercostal nerve (intercostobrachial nerve (ICBN)) and the medial branch of the brachial cutaneous nerve ( 6 ). The intercostobrachial nerve is not a branch of the brachial plexus; thus, it is out of reach of LA during the axillary block.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the Effect of Intercostobrachial Nerve Block with and Without Ultrasound Guidance on Tourniquet Pain After Axillary Block of Brachial Plexus: A Randomized Clinical Trial

et al. 2023

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Background: A tourniquet is used to control bleeding in the surgical field. Because part of the inner arm is innervated by the intercostobrachial nerve (ICBN), a tourniquet can cause intolerable pain. Objectives: The present study aimed to compare the effect of ICBN block with and without ultrasound (US) guidance on tourniquet pain after axillary block. Methods: This study was performed on 60 patients who were candidates for surgery. The patients were divided into 3 groups: the control group (n = 22), the traditional ICBN (TICBN) blockade group (n = 19), and the US-guided ICBN blockade group (n = 19). After the intervention, the duration of the onset and intensity of pain was recorded for all patients according to the Numeric Rating Scale (NRS). Data analysis was performed using SPSS. Results: No significant differences were observed in demographic variables between the 3 groups (P > 0.05). The pain intensity in the TICBN blockade (P = 0.001) and US-guided ICBN blockade (P = 0.001) groups was significantly less than in the control group. The mean duration of pain onset was significantly higher in the TICBN blockade (P = 0.021) and US-guided ICBN blockade (P = 0.013) groups than in the control group. No significant difference was observed in the mean of pain intensity (P = 0.48) and the mean duration of pain onset (P = 0.44) between the US-guided ICBN blockade and TICBN blockade groups. Conclusions: The pain caused by a tourniquet can be managed by ICBN block during hand and forearm surgery. It is recommended to use US guidance for more success and safety.

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Cadaveric study identifying clinical sonoanatomy for proximal and distal approaches of ultrasound-guided intercostobrachial nerve block

Samerchua

Leurcharusmee

Panjasawatwong

et al. 2020

Reg Anesth Pain Med

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Background and objectivesThe intercostobrachial nerve (ICBN) has significant anatomical variation. Localization of the ICBN requires an operator’s skill. This cadaveric study aims to describe two simple ultrasound-guided plane blocks of the ICBN when it emerges at the chest wall (proximal approach) and passes through the axillary fossa (distal approach).MethodsThe anatomical relation of the ICBN and adjacent structures was investigated in six fresh cadavers. Thereafter, we described two potential techniques of the ICBN block. The proximal approach was an injection medial to the medial border of the serratus anterior muscle at the inferior border of the second rib. The distal approach was an injection on the surface of the latissimus dorsi muscle at 3–4 cm caudal to the axillary artery. The ultrasound-guided proximal and distal ICBN blocks were performed in seven hemithoraxes and axillary fossae. We recorded dye staining on the ICBN, its branches and clinically correlated structures.ResultsAll ICBNs originated from the second intercostal nerve and 34.6% received a contribution from the first or third intercostal nerve. All ICBNs gave off axillary branches in the axillary fossa and ran towards the posteromedial aspect of the arm. Following the proximal ICBN block, dye stained on 90% of all ICBN’s origins. After the distal ICBN block, all terminal branches and 43% of the axillary branches of the ICBN were stained.ConclusionsThe proximal and distal ICBN blocks, using easily recognized sonoanatomical landmarks, provided consistent dye spread to the ICBN. We encourage further validation of these two techniques in clinical studies.

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New approach for blocking intercostobrachial and medial brachial cutaneous nerve in the axillary area: response to Varela

Cited by 4 publications

References 4 publications

Ultrasound‐guided fascial plane blocks for post‐breast surgery pain syndrome

Ultrasound‐guided fascial plane blocks for post‐breast surgery pain syndrome

Comparison of the Effect of Intercostobrachial Nerve Block with and Without Ultrasound Guidance on Tourniquet Pain After Axillary Block of Brachial Plexus: A Randomized Clinical Trial

Cadaveric study identifying clinical sonoanatomy for proximal and distal approaches of ultrasound-guided intercostobrachial nerve block

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