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Garry Buckland - One of the best experts on this subject based on the ideXlab platform.
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A Novel Technique of Intraoperative Lateral Pectoral Nerve Block During SubPectoral Breast Implant Placement.
Plastic and reconstructive surgery. Global open, 2016Co-Authors: Nicholas Bernard Haydon, Rhys Van Der Rijt, Catherine Downs, Garry BucklandAbstract:We report a novel technique of intraoperative Lateral Pectoral Nerve block under direct vision for analgesia after subPectoral implant placement for breast reconstruction. Breast surgery is one of the most frequently performed surgeries in hospitals, and even minor breast surgery can be associated with significant postoperative pain.1 Blanco et al2 describe the “pecs block” of the Lateral Pectoral Nerve under ultrasound guidance, which was found to be particularly useful for patients who have had breast expanders and implants. Similarly, Semenza3 reported a case of successful ultrasound-guided blockade of the Lateral Pectoral Nerve to improve postoperative analgesia after submuscular breast augmentation. Leiman et al4 report blockade of the medial and Lateral Pectoral Nerves under ultrasound guidance that results in complete relaxation of the Pectoralis major and reduction in postoperative pain. The paravertebral approach providing multilevel intercostal Nerve block is another technique providing a similar level of analgesia that we have used for such breast cases. It also provides excellent analgesia, similar to that seen with skin infiltration plus Lateral Pectoral Nerve block but accessing the paravertebral or intercostal space always carries a small risk of accidental pneumothorax.5 Although thoracic intercostal Nerves provide sensory innervation to the breast, significant pain afferents from the muscle are carried by the Lateral Pectoral Nerve after submuscular prosthesis placement.3 The Pectoralis major muscle is principally supplied by the Lateral Pectoral Nerve via spinal segments C5, C6, and C7 and the medial Pectoral Nerve (C8, T1). The Lateral Pectoral Nerve is readily visualized emerging from the claviPectoral fascia along with the Pectoral branch of the thoracoacromial artery during elevation of the Pectoralis major muscle; the medial Pectoral Nerve (C8, T1) pierces Pectoralis minor to run on the undersurface of Pectoralis major and supplies the lower costal fibers.6 Submuscular implant placement, therefore, provides an opportune time to block the Lateral Pectoral Nerve (and communicating fibers from medial Pectoral Nerve) intraoperatively. During surgery, for postmastectomy breast reconstruction or cosmetic subPectoral implants, the Pectoralis major muscle is elevated from its inferoLateral aspect. Once the muscle is dissected off its costal attachments, blunt dissection is carried out until the Lateral Pectoral Nerve is visualized emerging from the claviPectoral fascia. Using a blunt tip cannula, 10 mL of 0.75% ropivacaine is infiltrated around the Lateral Pectoral Nerve under direct visualization. Blockade of the Nerve is conducted just before implant placement (Fig. (Fig.11). Fig. 1. Schematic demonstrating the Lateral Pectoral Nerve emerging from the claviPectoral fascia with the Pectoral branch of the thoracoacromial artery and the cephalic vein (Pectoralis major muscle cut and reflected). We routinely do this procedure on all subPectoral prosthetic breast reconstructions and subPectoral breast augmentation and agree with Blanco et al2 that it significantly reduces postoperative pain and opiate requirements. Before introduction of the Lateral Pectoral Nerve block, our usual practice was to prescribe regular paracetamol and COX 2 NSAID with a patient controlled analgesia device containing fentanyl. With the use of routine Lateral Pectoral Nerve block performed by the surgeon before insertion of the subPectoral prosthesis, most of our patients no longer utilize the patient controlled analgesia device and manage their postoperative pain with paracetamol and NSAIDS with the additional likely benefit of reducing the opiate-related side effects of sedation, nausea, and constipation. Further studies should quantify the efficacy of this block by assessing postoperative opiate requirements and patient satisfaction (Fig. (Fig.22). Fig. 2. Intraoperative image—left breast inframammary fold incision, visualizing the Lateral Pectoral Nerve on the undersurface of the Pectoralis major muscle.
Ece Ünlü - One of the best experts on this subject based on the ideXlab platform.
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the effect of Lateral Pectoral Nerve sparing technique and radiotherapy on the Pectoralis major muscle applied with modified radical mastectomy
Asian Journal of Surgery, 2019Co-Authors: Muzaffer Akkoca, Mehlika Panpallı Ateş, Kerim Bora Yılmaz, İnanç İmamoğlu, Şener Balas, Serhat Tokgöz, Melih Akıncı, Harun Karabacak, Ece ÜnlüAbstract:Summary Background/Objective The aim of this study was to evaluate with electromyography (EMG) the effect of Lateral Pectoral Nerve sparing technique (LPNST) and radiotherapy (RT) on the Lateral Pectoral Nerve (LPN) in patients applied with modified radical mastectomy (MRM). Methods The study included 66 patients who underwent MRM surgery. The patients were separated into 2 groups as those applied with LPNST and those who underwent standard surgery (Control group). Within these 2 groups, patients were again separated as those who received or did not receive RT. The EMG evaluations were made by a neurology specialist blinded to the patient groups. Results The mean age of the patients was 53.3 ± 10.6 years. Standard surgery was applied to 33 (50%) patients and LPNST to 33 (50%) patients, RT was applied to 32 (48.5%) patients and not to 34 (51.5%) patients. In the EMG evaluation, latency was 2.1 ms (1.4–3.2) in the LPNST and 3.7 ms (1.9–12.4) in the control (p 0.001) and amplitude values were 9650 mV (3120–36900) in the LPNST and 4780 mV (510–12.4) in the control (p 0.001) . The latency values in the Control receiving and not receiving RT were 4.0 ms (1.9–12.4) and 2.6 ms (1.9–6.2) respectively (p 0.05) . The latency values of the patients receiving and not receiving RT in the LPNST were 2.2 ms (1.8–3.2) and 2.0 ms (1.4–2.4) respectively (p 0.05) . In the Control and LPNST Group, no significant difference was determined between receiving and not receiving RT groups in respect of amplitude values (p > 0.05) . Conclusion The results of this study demonstrated that electromyographically the latency and amplitude values were better protected in the LPNST group. It was also seen that RT increased the formation of Nerve damage in both groups.
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The effect of Lateral Pectoral Nerve sparing technique and radiotherapy on the Pectoralis major muscle applied with modified radical mastectomy
Elsevier, 2019Co-Authors: Muzaffer Akkoca, Mehlika Panpallı Ateş, Kerim Bora Yılmaz, İnanç İmamoğlu, Şener Balas, Serhat Tokgöz, Melih Akıncı, Harun Karabacak, Ece ÜnlüAbstract:Summary: Background/Objective: The aim of this study was to evaluate with electromyography (EMG) the effect of Lateral Pectoral Nerve sparing technique (LPNST) and radiotherapy (RT) on the Lateral Pectoral Nerve (LPN) in patients applied with modified radical mastectomy (MRM). Methods: The study included 66 patients who underwent MRM surgery. The patients were separated into 2 groups as those applied with LPNST and those who underwent standard surgery (Control group). Within these 2 groups, patients were again separated as those who received or did not receive RT. The EMG evaluations were made by a neurology specialist blinded to the patient groups. Results: The mean age of the patients was 53.3 ± 10.6 years. Standard surgery was applied to 33 (50%) patients and LPNST to 33 (50%) patients, RT was applied to 32 (48.5%) patients and not to 34 (51.5%) patients. In the EMG evaluation, latency was 2.1 ms (1.4–3.2) in the LPNST and 3.7 ms (1.9–12.4) in the control (p < 0.001) and amplitude values were 9650 mV (3120–36900) in the LPNST and 4780 mV (510–12.4) in the control (p < 0.001). The latency values in the Control receiving and not receiving RT were 4.0 ms (1.9–12.4) and 2.6 ms (1.9–6.2) respectively (p < 0.05). The latency values of the patients receiving and not receiving RT in the LPNST were 2.2 ms (1.8–3.2) and 2.0 ms (1.4–2.4) respectively (p < 0.05). In the Control and LPNST Group, no significant difference was determined between receiving and not receiving RT groups in respect of amplitude values (p > 0.05). Conclusion: The results of this study demonstrated that electromyographically the latency and amplitude values were better protected in the LPNST group. It was also seen that RT increased the formation of Nerve damage in both groups. Keywords: Modified radical mastectomy, Radiotherapy, Electromyography, Lateral Pectoral Nerve, Pectoralis major muscl
Edward G Mcfarland - One of the best experts on this subject based on the ideXlab platform.
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innervation of the human shoulder joint and its implications for surgery
Clinical Orthopaedics and Related Research, 1996Co-Authors: Oskar C Aszmann, A L Dellon, Brent C Birely, Edward G McfarlandAbstract:The distribution and variability of the Nerves innervating the shoulder joint were determined in 25 fresh human adult cadavers using 3.5x magnification for dissection. The results showed that 100% of the specimens had dual innervation of the coracoclavicular ligaments, the subacromial bursa, and the acromioclavicular joint. This dual innervation was from the articular branches of the suprascapular Nerve and of the Lateral Pectoral Nerve. Constant relationship of these 2 Nerves to bony landmarks will permit anesthetic blocks for diagnosis and possible therapeutic intervention. A consistent pattern of innervation of the posterior and inferior shoulder joints also is described.
Kenan Akgun - One of the best experts on this subject based on the ideXlab platform.
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Lateral Pectoral Nerve injury mimicking cervical radiculopathy
Clinical Journal of Sport Medicine, 2015Co-Authors: Ilknur Aktas, Deniz Palamar, Kenan AkgunAbstract:The Lateral Pectoral Nerve (LPN) is commonly injured along with the brachial plexus, but its isolated lesions are rare. Here, we present a case of an isolated LPN lesion confused with cervical radiculopathy. A 41-year-old man was admitted to our clinic because of weakness in his right arm. Previous magnetic resonance imaging (MRI) examination revealed right posteroLateral protrusion at the C6-7 level. At the initial assessment, atrophy of the right Pectoralis major muscle was evident, and mild weakness of the right shoulder adductor, internal rotator, and flexor muscles was observed. Therefore, electrodiagnostic evaluation was performed, and a diagnosis of isolated LPN injury was made. Nerve injury was thought to have been caused by weightlifting exercises and traction injury. Lateral Pectoral Nerve injury can mimic cervical radiculopathy, and MRI examination alone may lead to misdiagnosis. Repeated physical examinations during the evaluation and treatment phase will identify the muscle atrophy that occurs 1 or more months after the injury.
Nicholas Bernard Haydon - One of the best experts on this subject based on the ideXlab platform.
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A Novel Technique of Intraoperative Lateral Pectoral Nerve Block During SubPectoral Breast Implant Placement.
Plastic and reconstructive surgery. Global open, 2016Co-Authors: Nicholas Bernard Haydon, Rhys Van Der Rijt, Catherine Downs, Garry BucklandAbstract:We report a novel technique of intraoperative Lateral Pectoral Nerve block under direct vision for analgesia after subPectoral implant placement for breast reconstruction. Breast surgery is one of the most frequently performed surgeries in hospitals, and even minor breast surgery can be associated with significant postoperative pain.1 Blanco et al2 describe the “pecs block” of the Lateral Pectoral Nerve under ultrasound guidance, which was found to be particularly useful for patients who have had breast expanders and implants. Similarly, Semenza3 reported a case of successful ultrasound-guided blockade of the Lateral Pectoral Nerve to improve postoperative analgesia after submuscular breast augmentation. Leiman et al4 report blockade of the medial and Lateral Pectoral Nerves under ultrasound guidance that results in complete relaxation of the Pectoralis major and reduction in postoperative pain. The paravertebral approach providing multilevel intercostal Nerve block is another technique providing a similar level of analgesia that we have used for such breast cases. It also provides excellent analgesia, similar to that seen with skin infiltration plus Lateral Pectoral Nerve block but accessing the paravertebral or intercostal space always carries a small risk of accidental pneumothorax.5 Although thoracic intercostal Nerves provide sensory innervation to the breast, significant pain afferents from the muscle are carried by the Lateral Pectoral Nerve after submuscular prosthesis placement.3 The Pectoralis major muscle is principally supplied by the Lateral Pectoral Nerve via spinal segments C5, C6, and C7 and the medial Pectoral Nerve (C8, T1). The Lateral Pectoral Nerve is readily visualized emerging from the claviPectoral fascia along with the Pectoral branch of the thoracoacromial artery during elevation of the Pectoralis major muscle; the medial Pectoral Nerve (C8, T1) pierces Pectoralis minor to run on the undersurface of Pectoralis major and supplies the lower costal fibers.6 Submuscular implant placement, therefore, provides an opportune time to block the Lateral Pectoral Nerve (and communicating fibers from medial Pectoral Nerve) intraoperatively. During surgery, for postmastectomy breast reconstruction or cosmetic subPectoral implants, the Pectoralis major muscle is elevated from its inferoLateral aspect. Once the muscle is dissected off its costal attachments, blunt dissection is carried out until the Lateral Pectoral Nerve is visualized emerging from the claviPectoral fascia. Using a blunt tip cannula, 10 mL of 0.75% ropivacaine is infiltrated around the Lateral Pectoral Nerve under direct visualization. Blockade of the Nerve is conducted just before implant placement (Fig. (Fig.11). Fig. 1. Schematic demonstrating the Lateral Pectoral Nerve emerging from the claviPectoral fascia with the Pectoral branch of the thoracoacromial artery and the cephalic vein (Pectoralis major muscle cut and reflected). We routinely do this procedure on all subPectoral prosthetic breast reconstructions and subPectoral breast augmentation and agree with Blanco et al2 that it significantly reduces postoperative pain and opiate requirements. Before introduction of the Lateral Pectoral Nerve block, our usual practice was to prescribe regular paracetamol and COX 2 NSAID with a patient controlled analgesia device containing fentanyl. With the use of routine Lateral Pectoral Nerve block performed by the surgeon before insertion of the subPectoral prosthesis, most of our patients no longer utilize the patient controlled analgesia device and manage their postoperative pain with paracetamol and NSAIDS with the additional likely benefit of reducing the opiate-related side effects of sedation, nausea, and constipation. Further studies should quantify the efficacy of this block by assessing postoperative opiate requirements and patient satisfaction (Fig. (Fig.22). Fig. 2. Intraoperative image—left breast inframammary fold incision, visualizing the Lateral Pectoral Nerve on the undersurface of the Pectoralis major muscle.
