Breast Block

Published on 06/02/2015 by admin

Filed under Anesthesiology

Last modified 06/02/2015

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32 Breast Block

Perspective

There is increasing emphasis on carrying out “lesser” surgical procedures for breast cancer. These lesser procedures often consist of lumpectomy or simple mastectomy and avoid extensive chest wall procedures that in the past also involved shoulder structures. For this reason, breast blocks may become more appropriate for women undergoing operations for breast cancer.

Patient Selection

Any individual requiring a breast surgical procedure is a candidate for breast block, although appropriate sedation for the block and procedure must be kept in mind.

Pharmacologic Choice

This block is designed to provide sensory block rather than motor block. For this reason, lower concentrations of local anesthetic are possible. For example, 0.75% to 1% lidocaine or mepivacaine is appropriate, as is 0.25% bupivacaine or 0.2% ropivacaine if longer duration of postoperative analgesia is the goal.

Placement

Anatomy

The nerves that must be blocked to carry out the breast block are the second through seventh intercostal (ventral rami for paravertebral) nerves and some terminal branches from the superficial cervical plexus (Fig. 32-1).

Figure 32-1. Breast block anatomy: dermatomes.

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