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. Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: Distal Upper Extremity Block Translaryngeal Block Supraclavicular Block Sciatic Block Superior Hypogastric Plexus Block Celiac Plexus Block Tags: Atlas of Regional Anesthesia May 31, 2016 | Posted by admin in ANESTHESIA | Comments Off on Breast Block Full access? Get Clinical Tree
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. Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: Distal Upper Extremity Block Translaryngeal Block Supraclavicular Block Sciatic Block Superior Hypogastric Plexus Block Celiac Plexus Block Tags: Atlas of Regional Anesthesia May 31, 2016 | Posted by admin in ANESTHESIA | Comments Off on Breast Block Full access? Get Clinical Tree
