Evidence map›Paper›PMID 41087007›Full record

ArticleActa anaesthesiologica Scandinavica2025

Spread of Injectate After Combined Deep Serratus Anterior and Superficial Parasternal Intercostal Plane Injections: A Cadaver Study to Evaluate Their Utility in Breast Surgery.

Abhijit Biswas, Vivienne P Hang, William Newmarch, Kody M Wolfstadt, Christopher Hansebout, Anne Agur, Timothy D Wilson, Vishal Uppal

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Article in Acta anaesthesiologica Scandinavica, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Abhijit BiswasDepartment of Anesthesia and Perioperative Medicine, Western University, London, Ontario, Canada.ORCID 0000-0001-6352-7844
Vivienne P HangDepartment of Anatomy and Cell Biology, Western University, London, Ontario, Canada.
William NewmarchDepartment of Anesthesia and Perioperative Medicine, Western University, London, Ontario, Canada.
Kody M WolfstadtDepartment of Anatomy and Cell Biology, Western University, London, Ontario, Canada.
Christopher HanseboutDepartment of Anesthesia and Perioperative Medicine, Western University, London, Ontario, Canada.
Anne AgurDivision of Anatomy, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Timothy D WilsonDepartment of Anatomy and Cell Biology, Western University, London, Ontario, Canada.ORCID 0000-0001-7102-2491
Vishal UppalDepartment of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Canada and Nova Scotia Health Authority, Halifax, Nova Scotia, Canada.ORCID 0000-0001-7263-2072

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAnalgesia for breast surgery by a single peripheral nerve block is challenging as breast tissue receives innervation from multiple sources. In this cadaveric study, we evaluated the injectate spread of combined superficial parasternal intercostal plane (PIP) and deep serratus anterior plane (SAP) injections in the tissues relevant for breast surgery analgesia.

methodsWe performed ultrasound-guided dye injections in 18 hemithoraces. 20 mL of methylene blue solution was injected into the superficial PIP at the fourth rib. Following that, 20 mL of black India Ink solution was injected in the SAP at the fourth rib at the midaxillary line. We dissected the specimens, 15 min post-injection to visualize dye dispersion. Staining of the intercostal nerves from each injection was measured by counting the number of intercostal spaces and nerves stained.

resultsFor PIP injections, the cranial spread of injectate was observed up to the second intercostal nerve involving the anterior cutaneous branch in 14/16 (87.5%) with caudal spread to the fifth intercostal nerve in 15/16 (94%). In addition, the staining of the medial and lateral pectoral nerves was noted in 14/16 (88%) of the specimens. For the SAP dye injections, the cranial spread of injectate was observed up to the lateral cutaneous branch of the third intercostal nerve level in 9/16 (56%) of specimens and caudal spread up to the lateral cutaneous branch of the sixth intercostal nerve in 14/16 (88%) specimens.

conclusionsThis study demonstrated extensive spread of dye injectate with combined PIP and SAP injections involving anterior and lateral cutaneous branches of intercostal nerves and lateral and medial pectoral nerves. This study demonstrates an alternative analgesic approach to provide perioperative analgesia for breast surgery. EDITORIAL COMMENT: This cadaver study demonstrates that combining deep serratus anterior block with parasternal intercostal plane block provides reliable injectate spread to the cutaneous branches of intercostal nerves. In a clinical setting, this could provide comprehensive analgesia for the breast. Compared with paravertebral blocks, the combination of two fascial plane blocks may offer a technically less challenging alternative with a lower risk of complications.

Indexed as

BreastIntercostal NervesNerve BlockCadaverColoring AgentsFemaleHumansInjectionsMethylene BlueUltrasonography, InterventionalColoring AgentsMethylene Blue

Identifiers

PMID41087007
PMCPMC12520806

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.