Anesthesia Technique for Breast Abscess Drainage
Never inject lidocaine directly into the center of a breast abscess—always infiltrate the local anesthetic in a field block pattern around the abscess perimeter. 1
Rationale for Peripheral Infiltration
The acidic environment within infected tissue significantly reduces local anesthetic efficacy through multiple mechanisms:
Infected tissue has a lower pH that prevents ionization of local anesthetics, making them unable to penetrate nerve membranes effectively and requiring substantially higher volumes to achieve adequate anesthesia 1
Direct injection into purulent material risks spreading infection into surrounding tissue planes and potentially into the bloodstream, increasing morbidity 1
Central injection disrupts the abscess cavity, potentially causing incomplete drainage and increasing the risk of recurrence 2, 3
Recommended Anesthetic Technique
Use a field block technique with generous volumes of lidocaine infiltrated circumferentially around the abscess:
Infiltrate local anesthetic into the skin and subcutaneous tissue surrounding the abscess using a small gauge needle to raise a dermal bleb, then deeper infiltration into the subcutaneous tissue and periosteum 1
Use 0.25% bupivacaine with maximum dose of 2 mg/kg or lidocaine (lignocaine) hydrochloride up to 3 mg/kg for extended anesthesia duration 1
Manufacturer recommended maximum doses of 7 mg/kg of lidocaine with epinephrine and 4.5 mg/kg without epinephrine are safe for local infiltration in adults 1
Liberal use of anesthetic volume is appropriate given the reduced efficacy in infected tissue—the acidic pH requires more anesthetic to achieve the same effect 1
Alternative Approaches for Breast Abscess Management
Consider ultrasound-guided aspiration with antibiotics as first-line treatment rather than incision and drainage, as this approach has demonstrated 95-96% success rates with excellent cosmetic outcomes 2, 3, 4:
Needle aspiration combined with oral antibiotics successfully treats the majority of non-lactational breast abscesses without requiring general anesthesia or hospital admission 2, 5
Repeated aspiration (average 2.4 procedures) may be necessary for complete resolution, particularly for larger abscesses 2, 4
If surgical drainage is required, it can be performed in the office setting under local anesthesia using the peripheral field block technique described above 5, 6
Critical Technical Points
When surgical drainage is necessary:
Make the skin incision as close to the lesion as possible to optimize cosmetic results and avoid tunneling 1
Use curvilinear incisions following Langer's lines for optimal cosmesis in most breast locations 1, 7
Meticulous hemostasis is critically important as hematoma formation complicates postoperative evaluation and can lead to unnecessary future interventions 1, 7