title: [Ultrasound-assisted approach to blocking the intercostal nerves in the mid-axillary line for non-reconstructive breast and axilla surgery].
abstract: BACKGROUND
  Several nerve blocks have recently been used for pain treatment in breast surgery. The main objective of our study was to determine the efficacy and safety of ultrasound-assisted blocking of the anterior and lateral cutaneous branches of the intercostal nerves in the mid-axillary line for non-reconstructive breast and axilla surgery.
  
  
  METHODS
  A prospective observational study was conducted on 30 patients scheduled for non-reconstructive breast and axilla surgery. An intercostal branches block was performed in the mid-axillary line with 0,5% levobupivacaine (3ml in each intercostal space). Clinical efficacy was assessed by standard intraoperative hemodynamic response to surgical stimulus and the need for opioids, and in the postoperative period, by assessing pain intensity as a verbal numerical scale and the need for rescue treatment. We also evaluated the quality of sleep the first night after surgery, any adverse events that occurred, and the satisfaction of patients and surgeons with the anesthetic technique.
  
  
  RESULTS
  The intercostal branches block in the mid-axillary line was effective in most cases, with only 2 patients requiring intraoperative opioids, and in one case analgesic rescue was necessary in the postoperative period. The duration of postoperative analgesia was 19±4h. There were no notable adverse events or complications. The satisfaction with the chosen technique was assessed as "very good" in all patients, and by 97% of the surgeons.
  
  
  CONCLUSIONS
  Intercostal branches block in the mid-axillary line provides adequate intraoperative and postoperative analgesia for non-reconstructive breast and axilla surgery. It is a simple, reproducible technique in most patients of this study, with an easy to understand ultrasound anatomy, in which adequate analgesia could be provided through a single puncture, and may be an alternative to neuroaxial blocks.
authors.affiliation: Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Abente y Lago, Complejo Hospitalario Universitario A Coruña, A Coruña, España. Electronic address: paula.dieguez.garcia@sergas.es.
authors.forename: P
authors.initials: P
authors.lastname: Diéguez García
authors.forename: M
authors.initials: M
authors.lastname: Fajardo Pérez
authors.forename: S
authors.initials: S
authors.lastname: López Álvarez
authors.forename: P
authors.initials: P
authors.lastname: Alfaro de la Torre
authors.forename: A P
authors.initials: AP
authors.lastname: Pensado Castiñeiras
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000698:Analgesia / Q000379:methods; D001365:Axilla / Q000000981:diagnostic imaging / Q000601:surgery*; D001940:Breast / Q000601:surgery*; D001943:Breast Neoplasms / Q000601:surgery; D004396:Coloring Agents; D005260:Female; D006801:Humans; D007367:Intercostal Nerves / Q000000981:diagnostic imaging / Q000187:drug effects*; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D008408:Mastectomy / Q000379:methods*; D008751:Methylene Blue; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010149:Postoperative Pain / Q000517:prevention & control; D011446:Prospective Studies; D018084:Ultrasonography, Interventional; D016217:Ultrasonography, Mammary / Q000379:methods*; D055815:Young Adult
chemical_list: D004396:Coloring Agents; D008751:Methylene Blue
keywords: Anestesia regional; Bloqueo nervioso; Intercostal nerves; Mastectomía segmentaria; Nerve block; Nervios intercostales; Regional anesthesia; Segmental mastectomy