Dual Nerve Block May Provide Superior Pain Control During Breast Cancer Surgery, Reduce Risk of Chronic Pain

Using two targeted injections of local anesthetic medication may provide a comprehensive, effective means of pain control during breast cancer surgery, found a study by researchers at Western University, London, Ontario, Canada. Effective pain control during surgery is critical, as it improves the patient experience and can help reduce the risk of developing chronic pain. However, the complex nerve supply of breast tissue can make pain management challenging for anesthesia providers.

The primary nerve supply of breast tissue is derived from branches of the 2nd to 6th thoracic intercostal nerves, which run beneath the ribs. Various techniques have been developed to “freeze” these nerves using local anesthetic medications to improve pain control. Medication is injected at specific locations to target as many of these nerve branches as possible. Unfortunately, none of these techniques have shown the ability to anesthetize the whole breast.

The study, “Serratus Anterior and Parasternal Intercostal Block: A Cadaveric Study to Evaluate Combined Utility in Breast Surgery,” examined a combination of two separate nerve injections (“blocks”) in an attempt to provide pain control to the entire breast. Using a cadaver model, researchers injected dye into the superficial parasternal intercostal plane (PIP) and the deep serratus anterior plane (SAP) to determine the potential spread of anesthetic medication.

The combined spread of dye consistently targeted branches of the 2nd to 6th thoracic intercostal nerves. Furthermore, the lateral and medial pectoral nerves, located nearby, were also consistently stained with dye, which may provide additional benefits for pain control.

“Moving forward, this novel technique will need to be tested clinically to determine if it truly provides effective pain control for breast surgery,” said lead author William Newmarch, MD. “A randomized control trial comparing this comprehensive block to conventional pain management is already underway. We are hopeful that our promising results will form a basis for continued research in this area.”

Dr. Newmarch will present the abstract, chosen for a Resident/Fellow Travel Award, at a session on Thursday, April 20, at 1:30 pm, at the 48th Annual Regional Anesthesiology and Acute Pain Medicine Meeting at The Diplomat Beach Resort in Hollywood, FL. Co-authors are Drs. Vivienne Hang, Kody Wolfstadt, Christopher Hansebout, Anne Agur, Karen Boretsky, Timothy Wilson, and Abhijit Biswas.

ASRA Pain Medicine is a membership society of more than 5,000 healthcare professionals devoted to advancing evidence-based practice of pain medicine across the pain continuum, from acute pain 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 relieve the global burden of pain. We are committed to integrity, innovation, inclusiveness, service, compassion, and wellness. Learn more at www.asra.com.