Ultrasound to the Rescue: Axillary Clearance under Complete Regional Blockade

Abstract

No single regional anaesthetic technique is capable of complete anaesthesia of the axillary region. Regional or interfascial nerve blockade could be an effective alternative where administering general anaesthesia is not feasible, with superior analgesia, favourable haemodynamics, and reduced opiate related adverse effects. Ultrasound guidance improves effectiveness and safety profile. We report a case of a successful axillary clearance conducted under combined regional blocks for an axillary nodal recurrence following mastectomy for a breast carcinoma, in a patient who was not fit for general anaesthesia due to a persistent lobar pneumonia and recurrent asthma exacerbations. Our experience and current evidence supersede the initial conceptions of difficult ultrasonic intercostobrachial nerve (ICBN) visualization.

Beyond the Brachial Plexus: Reapplication of the Thoracic Paravertebral Block for Upper Arm Fistula Surgery

“…Anesthetic coverage via a brachial plexus block alone is often inadequate, particularly when the surgical procedure extends into the proximal axilla. Although inclusion of an ICBN (T2) covers the T2 dermatomal distribution outside of the brachial plexus (C5-T1) [4,5], the ICBN performed subcutaneously may only achieve 50-90% adequate coverage with significant anatomic variability [6,7]. A high thoracic PVB can mitigate this weakness by supplying coverage of the necessary T1-2 dermatomes.…”

“…Because the ICBN originates from the T2 nerve root below the C5-T1 nerve roots comprising the brachial plexus, brachial plexus blocks are ideally supplemented with an ICBN infiltration block for medial, upper arm coverage [4,5]. Unfortunately, the ICBN block performed subcutaneously may only achieve 50-90% adequate coverage [6], likely stemming from significant anatomic variability [7].…”

Comparison between thoracic paravertebral block and segmental thoracic spinal anesthesia in breast cancer surgery

“…General anesthesia (GA) is commonly used for breast cancer surgery. However, in the time of COVID-19 (Días et al 2021 ), and in some critical patients, regional anesthesia may be used as a sole technique including high thoracic epidural anesthesia (Yektas et al 2014 ; Rangrez et al 2020 ); combined facial plane blocks (Días et al 2021 ; Gutiérrez et al 2019 ; Munasinghe et al 2021 ); paravertebral block (Buckenmaier et al 2002 ; Oğuz et al 2007 ; Nikam et al 2014 ; Pangthipampai et al 2020 ); segmental thoracic spinal anesthesia (Elakany and Abdelhamid 2013 ; Madishetti et al 2017 ; Caruselli and Michel 2020 ); and tumescent anesthesia (Khater et al 2017 ).…”

In response to ‘Mastectomy under Local Anesthesia in Locally Advanced Breast Cancer in an Unfit Patient

“…To the editor, We read with interest the article 'Mastectomy under Local Anesthesia in Locally Advanced Breast Cancer in an Unfit Patient' by Irshad et al (1). We have made the following observations based on our institutional experience (2) and evidence-based contemporary medical literature.…”