Torre Patricia Alfaro de la, Jones Jerry Wayne, Álvarez Servando López, Garcia Paula Diéguez, Miguel Francisco Javier Garcia de, Rubio Eva Maria Monzon, Boeris Federico Carol, Sacramento Monir Kabiri, Duany Osmany, Pérez Mario Fajardo, Gordon Borja de la Quintana
Tajo University Hospital, Madri, Espanha.
University of Tennessee Health Science Center/Regional One Health, College of Medicine, Department of Anesthesiology, TN, EUA.
Rev Bras Anestesiol. 2017 Nov-Dec;67(6):555-564. doi: 10.1016/j.bjan.2016.10.009. Epub 2017 Sep 1.
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.
口服阿片类镇痛药已用于腋窝淋巴结清扫术患者围手术期和术后镇痛的管理。腋窝区域是一个难以阻滞的部位，目前尚无已发表的能提供充分阻滞效果的特定区域麻醉技术。
经机构审查委员会批准后，进行了解剖学和放射学研究，以确定分别经胸筋膜平面注入腋窝的亚甲蓝和局麻药的沉积及扩散情况。然后，对34例计划进行单侧乳房手术（包括腋窝清扫、前哨淋巴结活检、腋窝淋巴结活检或副乳切除）的患者中的15例进行了磁共振成像研究，以确定溶液在体内胸筋膜平面内的沉积及扩散时间过程。
放射学和尸体研究表明，使用超声引导技术经胸筋膜平面注射局麻药和亚甲蓝，可使药物可靠地沉积于腋窝。在患者中，注射局麻药产生了可靠的腋窝感觉阻滞。磁共振成像研究显示腋窝区域有高强度信号，支持了这一发现。
这些发现明确了腋窝区域胸筋膜平面神经阻滞的解剖学特征，并突显了这种新型神经阻滞的临床潜力。
