Although this type of cancer is the most diagnosed worldwide, the path of treatment is not uniform as it varies per case. Female breast cancer is the fifth leading cause of cancer deaths globally and 60% of individuals who undergo surgery suffer from acute postoperative pain primarily concentrated in the axilla
With the help of postoperative analgesia being managed with intraoperative peripheral nerve blocks (PNBs), the intercostobrachial nerve (ICBN) is targeted 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 try and locate any additional or undocumented pathways, a group of researchers from the London Health Sciences Centre at Western University used anatomical dissection to expand sensory nerve identification. A total of nine axillary dissections were performed on a mix of soft-embalmed and fresh/frozen specimens. The authors reported that at each dissection, an ICBN and a branch of the posterior cord (PCB) were both found entering axillary subcutaneous tissue.
With further exploration, researchers reported that 55% (5 out of 9) of dissections included a branch of the medial cord (MCB). They concluded that PCB and MCB are separate entities. The ICBN remained localized to the anterior axillary base but presented various extra thoracic branching patterns. The ICBNs were present in 100% of the subjects, but the branch patterns were highly variable.
The study found that: “The identification of these additional nerves supplying the axilla is crucial information when administering local anesthetic for breast and axillary procedures. Determining relevant landmarks for these nerves will help to provide more accurate and targeted nerve block for axillary surgery.” The research abstract, “Journey to the center of the armpit: Mapping axillary sensory cutaneous nerves for enhanced analgesic approaches in breast surgery,” will be presented on March 21 at 8:15 am PT, during the 49th Annual Regional Anesthesiology and Acute Pain Medicine Meeting in San Diego, CA. 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 care 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.
