Axillary local anesthetic spread after the thoracic interfacial ultrasound block – a cadaveric and radiological evaluation

• Published in: Brazilian journal of anesthesiology (Elsevier) 2017-11, Vol.67 (6), p.555-564
• Main Authors: de la Torre, Patricia Alfaro, Jones, Jerry Wayne, Álvarez, Servando López, Garcia, Paula Diéguez, de Miguel, Francisco Javier Garcia, Rubio, Eva Maria Monzon, Boeris, Federico Carol, Sacramento, Monir Kabiri, Duany, Osmany, Pérez, Mario Fajardo, de la Quintana Gordon, Borja
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Anestesia por condução; Anesthesia, conduction; Anesthesia, Local - methods; ANESTHESIOLOGY; Anesthetics, Local - administration & dosage; Anesthetics, Local - pharmacokinetics; Axila; Axilla; Bloqueio do plexo braquial; Brachial plexus block; Cadaver; Excisão de linfonodo; Female; Humans; Intercostal muscles; Intercostal Muscles - diagnostic imaging; Intercostal nerves; Intercostal Nerves - diagnostic imaging; Lymph node excision; Male; Middle Aged; Músculos intercostais; Nerve Block - methods; Nervos intercostais; Ultrasonography; Ultrassonografia; Young Adult
• ISSN: 0104-0014; 1806-907X; 0104-0014; 1806-907X
• DOI: 10.1016/j.bjane.2015.04.007

Oral opioid analgesics have been used for management of peri- and postoperative analgesia in patients undergoing axillary dissection. The axillary region is a difficult zone to block and does not have a specific regional anesthesia technique published that offers its adequate blockade. After institutional review board approval, anatomic and radiological studies were conducted to determine the deposition and spread of methylene blue and local anesthetic injected respectively into the axilla via the thoracic inter-fascial plane. Magnetic Resonance Imaging studies were then conducted in 15 of 34 patients scheduled for unilateral breast surgery that entailed any of the following: axillary clearance, sentinel node biopsy, axillary node biopsy, or supernumerary breasts, to ascertain the deposition and time course of spread of solution within the thoracic interfascial plane in vivo. Radiological and cadaveric studies showed that the injection of local anesthetic and methylene blue via the thoracic inter-fascial plane, using ultrasound guide technique, results in reliable deposition into the axilla. In patients, the injection of the local anesthetic produced a reliable axillary sensory block. This finding was supported by Magnetic Resonance Imaging studies that showed hyper-intense signals in the axillary region. These findings define the anatomic characteristics of the thoracic interfascial plane nerve block in the axillary region, and underline the clinical potential of this novel nerve block. Os analgésicos orais à base de opioides têm sido usados para o manejo da analgesia nos períodos peri e pós-operatório de pacientes submetidos à linfadenectomia axilar. A região axilar é uma zona difícil de bloquear e não há registro de uma técnica de anestesia regional específica que ofereça o seu bloqueio adequado. Após a aprovação do Conselho de Ética institucional, estudos anatômicos e radiológicos foram realizados para determinar a deposição e disseminação de azul de metileno e anestésico local, respectivamente injetados na axila via plano interfascial torácico. Exames de ressonância magnética foram então realizados em 15 de 34 pacientes programados para cirurgia de mama unilateral envolvendo qualquer um dos seguintes procedimentos: esvaziamento axilar, biópsia de linfonodo sentinela, biópsia de linfonodo axilar, ou mamas supranumerárias, para verificar a deposição e tempo de propagação da solução dentro do plano interfascial torácico in vivo. Estudos radiológicos e em