The detailed discussion by Porter et al.1 on optimizing safety when performing paravertebral blockade is a technique we are familiar with and also endorse. We thank Porter et al.1 for highlighting this important anatomical consideration.
The cutaneous supply to the breast is derived from the anterior and lateral cutaneous branches of the intercostal nerves (1–7),2,3 blocked by a T4 paravertebral blockade. While blocking the pectoral nerves may assist in additional postoperative analgesia, to date there are no clinical trials comparing pectoral nerve blockade outcomes in subpectoral breast augmentation. This may well be an area of relevant future research.
Lastly, the final comment differentiating between clinical and statistical significance is important. It might be that the medians given in Table 4a don’t adequately convey the clinical situation. The attached boxplots (Figure 1) display the actual spread of the data. The difference is more apparent.
Sarah Gardiner, BMBS
Glenda Rudkin, MBBS, FANZCA
John Field, PhD, AStat
Rodney Cooter, MBBS, MD, FRACS
Waverley House Plastic Surgery Centre
Adelaide, South Australia, Australia
1. Porter SB, Robards CB, Clendenen SR. Walk down, not up to find the paravertebral space Anesth Analg. 2013;117:280––1
2. Sarhadi NS, Shaw Dunn J, Lee FD, Soutar DS. An anatomical study of the nerve supply of the breast, including the nipple and areola. Br J Plast Surg. 1996;49:156–64
3. Jaspars JJ, Posma AN, van Immerseel AA, Gittenberger-de Groot AC. The cutaneous innervation of the female breast and nipple-areola complex: implications for surgery. Br J Plast Surg. 1997;50:249–59