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#36516 Single injection posterior intercostal block. Can it be an alternative block for small breast surgeries? Case report
  1. Vanessa Carvalho,
  2. Aguida Guidolim,
  3. Sammyle Bezerra and
  4. Angelica Braga
  1. Anesthesiology, University of Campinas, Campinas, Brazil


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Background and Aims Multiple Intercostal nerve blocks had their role in the clinical scenario for small breast procedures. Agreeing with all new evidence of intercostal space spread of local anesthetic, we present a safe technique to block intercostal nerves by a single injection in the posterior intercostal space.

Methods We aimed to describe two case reports from two Middle-aged Women, one with a diagnosis of breast abscess and the other with a breast expander rejection. After signing the informed consent, both patients underwent the anesthetic procedure with standard monitoring, received light IV sedation, positioned in lateral decubitus with the up arm lying in front of them. A perpendicular line between the scapulae’s spine and the vertebral column was marked and the point of injection was placed 7 cm from the vertebral column. After local anesthesia, a Tuohy needle was inserted into this point at the superior angle of the rib, and a syringe with 4ml of saline was placed to test the loss of resistence (LOR) technique.

Abstract #36516 Figure 1

Us image – Posterior IC block

Results As the LOS was positive, lidocaine 2% 20ml with sufentanyl 5mcg was injected in fractionated doses associated with aspiration to avoid intravascular injection. The technique was tracked by an ultrasound image. The onset time was short and the efficacy was high.

Conclusions These two case reports come from the anatomical studies of the intercostal space, where some authors discussed the possibility of blocking many nerves with a single injection. A little change in the published technique and the addition of the ultrasound could make it safer.

Attachment Approved IRB BIPU.docx

  • Posterior Intercostal block
  • breast surgery

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