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Perioperative Breast Analgesia: A Qualitative Review of Anatomy and Regional Techniques

Woodworth, Glenn E. MD*; Ivie, Ryan M.J. MD*; Nelson, Sylvia M. PhD*; Walker, Cameron M. PhD*; Maniker, Robert B. MD

doi: 10.1097/AAP.0000000000000641
Regional Anesthesia and Acute Pain: Review Articles

Abstract: Breast surgery is exceedingly common and may result in significant acute as well as chronic pain. Numerous options exist for the control of perioperative breast pain, including several newly described regional anesthesia techniques, but anesthesiologists have an insufficient understanding of the anatomy of the breast, the anatomic structures disrupted by the various breast surgeries, and the theoretical and experimental evidence supporting the use of the various analgesic options. In this article, we review the anatomy of the breast, common breast surgeries and their potential anatomic sources of pain, and analgesic techniques for managing perioperative pain. We performed a systematic review of the evidence for these analgesic techniques, including intercostal block, epidural administration, paravertebral block, brachial plexus block, and novel peripheral nerve blocks.

From the *Department of Anesthesiology & Perioperative Medicine, Oregon Health and Science University, Portland, OR; and †Department of Anesthesiology, Columbia University, New York, NY.

Accepted for publication March 15, 2017.

Address correspondence to: Glenn E. Woodworth, MD, Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239 (e-mail: woodworg@ohsu.edu).

The authors declare no conflict of interest.

This work was funded by the Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, OR; and the Columbia University Department of Anesthesiology, New York, NY.

Copyright © 2017 by American Society of Regional Anesthesia and Pain Medicine.