Ultrasound‐Guided Intercostobrachial Nerve Block for Intercostobrachial Neuralgia in Breast Cancer Patients: A Case Series

Wisotzky, Eric; Saini, Vikramjeet; Kao, Cyrus

doi:10.1016/j.pmrj.2015.10.003

Cited by 36 publications

(12 citation statements)

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“…The ICBN can be damaged from any number of reasons ranging from traction to transection [32]. Additionally, damaged nerves may also develop neuromas that can further complicate the clinical picture [1, 32]. Surgeons in some cases must make decisions that have consequences in order to get the proper margins in oncologic surgery.…”

Section: Discussionmentioning

confidence: 99%

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Origin, Branching, and Communications of the Intercostobrachial Nerve: a Meta-Analysis with Implications for Mastectomy and Axillary Lymph Node Dissection in Breast Cancer

Henry¹,

Graves²,

Pękala³

et al. 2017

Cureus

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The intercostobrachial nerve (ICBN), which usually originates from the lateral cutaneous branch of the second intercostal nerve, innervates areas of the axilla, lateral chest, and medial arm. It is at risk for injury during operative procedures that are often used in the management of breast cancer and such injury has been associated with postoperative sensory loss and neuropathic pain, decreasing the quality of life. PubMed, Excerpta Medica Database (EMBASE), ScienceDirect, Google Scholar, China National Knowledge Infrastructure (CNKI), Scientific Electronic Library Online (SciELO), Biosciences Information Service (BIOSIS), and Web of Science were searched comprehensively. Data concerning the prevalence, branching, origin and communications of the ICBN were extracted and pooled into a meta-analysis. A total of 16 studies (1,567 axillas) reported data indicating that the ICBN was present in 98.4% of person. It most often (90.6%) originated from fibers at the T2 spinal level and commonly coursed in two branching patterns: as a single trunk in 47.0% of cases and as a bifurcating pattern in 42.2%. In the latter cases, the bifurcation was usually unequal (63.4%). Additionally, the ICBN presented with anastomosing communication to the brachial plexus in 41.3% of cases. The ICBN is a prevalent and variable structure at significant risk for injury during operative procedures of the axilla. In view of the postoperative pain and paresthesia experienced by patients following injury, surgeons need to exercise caution and aim to preserve the ICBN when possible. Ultimately, careful dissection and knowledge of ICBN anatomy could allow postoperative complications to be reduced and patient's quality of life increased.

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Section: Discussionmentioning

confidence: 99%

“…It should, however, be standard to exercise protective practices towards the ICBN when possible. ICBN neuralgia and post-mastectomy pain syndrome can be successfully managed with loco-regional anesthetic techniques, however, overall reduction in incidence should be the primary goal [4, 32]. …”

Section: Discussionmentioning

confidence: 99%

Origin, Branching, and Communications of the Intercostobrachial Nerve: a Meta-Analysis with Implications for Mastectomy and Axillary Lymph Node Dissection in Breast Cancer

Henry¹,

Graves²,

Pękala³

et al. 2017

Cureus

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“…Ultrasound-guided injections in breast cancer survivors are also reported scarcely in the literature. Trigger point injections in myofascial pain syndrome (18) and intercostobrachial nerve blocks (28) are successfully performed without complications. Realtime ultrasound helps the physician to precisely place the needle and correctly deliver the medication to the targeted site.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-Guided Block of the Suprascapular Nerve in Breast Cancer Survivors with Limited Shoulder Motion – Case Series

Okur¹,

Ozyemisci-Taskiran

Pekindogan³

et al. 2017

Pain Phys

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Background: Suprascapular nerve block is performed in the management of chronic shoulder pain and frozen shoulder. Objective: To investigate the effects of ultrasound-guided suprascapular nerve block in restoration of shoulder motion in breast cancer survivors. Study Design: A cohort study. Setting: A training and research hospital, outpatient setting. Methods: A total of 18 breast cancer survivors with limited shoulder motion, pain, and difficulty in positioning the upper extremity for radiation treatment following surgery were enrolled in this study. Ultrasound-guided suprascapular nerve blocks were performed while the patients were seated in a chair without a backrest. After visualization of the suprascapular nerve under the transverse suprascapular ligament, 20 mg of triamcinolone and 4 mL of 0.5% bupivacaine were injected. Shoulder range of motion, pain, disability, and upper extremity circumference measurements were assessed in all participants before and 10 days after the block. Results: A significant decrease was observed in severity of pain and disability 10 days after the block. The ranges of shoulder abduction, flexion, and external rotation were improved significantly. All patients were able to receive radiation therapy without delay. Limitations: Absence of a control group and absence of randomization reduces the strength of our findings. Small sample size and absence of long-term follow-up are other limitations of this study. Conclusions: This is the first study investigating the effect of ultrasound-guided suprascapular block on shoulder limitation in breast cancer survivors. The results demonstrate that it may be a promising treatment approach for rapid recovery of shoulder motion in women with breast cancer before radiation treatment. Key words: Breast cancer, upper extremity, shoulder pain, range of motion, disability, ultrasound, injection, triamcinolone, local anesthetics

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“…In addition, in patients with ICB Neuralgia, anaesthetists have started using ultrasound guided nerve blocks in the subpectoral plance. Aberrant branching patterns would affect the outcome of these procedures that bring relief to the patient (17).…”

Section: Discussionmentioning

confidence: 99%

Aberrant Cutaneous Nerve Loops in the Axilla

Deshmukh

Bhardwaj

Khan

et al. 2017

Acta Med. (Hradec Kralove, Czech Repub.)

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A B ST R AC T During routine dissection classes, conducted for first year undergraduate medical students, we encountered a rare anatomical variation in relation to the intercostobrachial nerve (ICBN). The ICBN represents the lateral undivided cutaneous branch of second intercostal nerve. In this case, the ICBN formed nerve loops with branches of the lateral cutaneous branch of the third intercostal nerve. These loops eventually gave branches that probably supplied the floor of the axilla and proximal arm. Nowadays, this ICBN is gaining clinical importance during the axillary lymph node dissections and mammary gland surgeries. Damage to the ICBN, may results in the sensory deficits in patients undergoing surgery. In our case report, ICBN was making aberrant nerve loop along with the branches from the third intercostal nerve. Knowledge regarding the origin, formation and route of ICBN is of clinical significance to axillary surgeons, radiologist and anesthesiologists. K E Y WO R D S axilla; lymph node; nerve plexus; intercostobrachial nerve; surgery

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Ultrasound‐Guided Intercostobrachial Nerve Block for Intercostobrachial Neuralgia in Breast Cancer Patients: A Case Series

Cited by 36 publications

References 12 publications

Origin, Branching, and Communications of the Intercostobrachial Nerve: a Meta-Analysis with Implications for Mastectomy and Axillary Lymph Node Dissection in Breast Cancer

Origin, Branching, and Communications of the Intercostobrachial Nerve: a Meta-Analysis with Implications for Mastectomy and Axillary Lymph Node Dissection in Breast Cancer

Ultrasound-Guided Block of the Suprascapular Nerve in Breast Cancer Survivors with Limited Shoulder Motion – Case Series

Aberrant Cutaneous Nerve Loops in the Axilla

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