Newswise – Although this type of cancer is the most commonly diagnosed worldwide, the treatment route is not uniform as it varies from case to case. Breast cancer in women is the fifth leading cause of cancer death worldwide and 60% of individuals undergoing surgery experience acute postoperative pain, primarily concentrated in the armpit
With the help of postoperative analgesia, which is controlled with intraoperative peripheral nerve blocks (PNBs), the intercostobrachial nerve (ICBN) is specifically addressed and provides sensory innervation to the axilla. Unfortunately, complete analgesia for axillary dissection with PNBs is not considered reliable as results are inconsistent. The incomplete coverage could be due to additional, undocumented innervation pathways.
To attempt to locate additional or undocumented pathways, a group of researchers at Western University’s London Health Sciences Center used anatomical dissection to expand the identification of sensory nerves. A total of nine axillary dissections were performed on a mixture of soft-embalmed and fresh/frozen specimens. The authors reported that in each dissection, both an ICBN and a branch of the posterior dorsal column (PCB) were found penetrating the subcutaneous tissue of the axilla.
Upon further investigation, researchers reported that 55% (5 of 9) of the dissections involved a branch of the medial spinal cord (MCB). They concluded that PCB and MCB are separate entities. The ICBN remained localized to the anterior axillary base but showed various branching patterns outside the thorax. The ICBNs were present in 100% of the subjects, but the branching patterns were highly variable.
The study found: “Identification of these additional nerves supplying the axilla is critical information when administering local anesthetics for breast and axillary procedures.” Identifying relevant landmarks for these nerves will help provide a more accurate and targeted nerve block during axillary surgery to provide.” The research summary: “Journey to the center of the axilla: mapping axillary sensory cutaneous nerves for improved analgesic approaches to breast surgery“” will be featured on March 21 at 8:15 a.m. PT during the 49th Annual Meeting for Regional Anesthesiology and Acute Pain Medicine in San Diego, California. The abstract was selected as one of the three “Best of Meeting Abstracts”. The authors are Abhijit Biswas, Brittany Zurkan and Timothy Wilson.
The American Society of Regional Anesthesia and Pain Medicine is a membership society of more than 5,000 health professionals committed to advancing the evidence-based practice of pain medicine across the pain continuum, from acute to chronic pain. Our mission is to advance the science and practice of regional anesthesia and pain medicine to improve patient outcomes through research, education and advocacy. Our vision is to ease the global burden of pain. We are committed to integrity, innovation, inclusivity, service, compassion and well-being. Find out more at www.asra.com.