From the FDA Drug Label
Lidocaine HCl Injections are indicated for production of local anesthesia by infiltration techniques such as percutaneous injection by peripheral nerve block techniques such as brachial plexus and intercostal, when the accepted procedures for these techniques as described in standard textbooks are observed. The intercostobrachial nerve can be blocked using peripheral nerve block techniques.
- Specifically, it can be blocked near the brachial plexus and intercostal areas, as these are the regions where the nerve is located. Based on the information provided in the drug label 1, it appears that the intercostobrachial nerve block can be performed in conjunction with these techniques.
From the Research
The intercostobrachial nerve can be blocked at the lateral border of the pectoralis major muscle in the axilla, specifically near the second intercostal space, using ultrasound guidance to improve accuracy. To perform this block, the patient should be positioned with the arm abducted to expose the axillary region. The nerve can be identified approximately 1-2 cm inferior to the axillary artery, where it courses from the chest wall toward the medial aspect of the upper arm. A local anesthetic such as 5-10 mL of 0.25-0.5% bupivacaine or 1-2% lidocaine can be infiltrated subcutaneously in a band-like fashion across this area.
Key Considerations for the Block
- The block is particularly useful for providing analgesia to the medial aspect of the upper arm and axilla during procedures such as axillary lymph node dissection or breast surgery.
- The intercostobrachial nerve is a sensory branch of the T2 spinal nerve, and blocking it prevents transmission of painful stimuli from the medial and posterior aspects of the upper arm without affecting motor function.
- Ultrasound guidance is recommended as it improves the accuracy of the block by visualizing the nerve as it emerges between the second intercostal space and travels toward the axilla, as demonstrated in studies such as 2 and 3.
Clinical Evidence Supporting the Block
- A study published in the Saudi Medical Journal in 2015 2 found that ultrasound imaging accurately identifies the intercostobrachial nerve, allowing for successful blockade with a small volume of local anesthetic.
- Another study published in the Pain Physician in 2016 3 demonstrated the feasibility and analgesic effect of ultrasound-guided intercostobrachial nerve blockade in patients with persistent pain after breast cancer surgery.
Important Anatomical Relations
- The intercostobrachial nerve has peripheral communications with the branches of the medial cord of the brachial plexus, as reported in a case study published in Advanced Biomedical Research in 2015 4.
- These anatomical relations are important to consider during axillary dissection for axillary lymph node dissection or exploration of long thoracic nerves to avoid sensory impairment and vascular complications.