Intercostobrachial nerve preservation averts arm numbness but prolongs axillary dissection

Preservation of the intercostobrachial nerve (ICBN) during axillary dissection in patients with breast cancer can prevent inner arm numbness at the expense of surgery duration, about 20 minutes longer, suggests a recent study. Thus, surgeons need to take their time in carefully dissecting the axilla without injuring the ICBN.

Preserving or sacrificing the ICBN remains a controversial issue. The investigators in this single-institution, single-surgeon randomized controlled trial assessed the impact of ICBN preservation during axillary dissection for breast cancer patients in terms of pain score immediately postoperatively and several hours later, need for simple analgesia and narcotics, numbness, and arm swelling.

Forty-eight breast cancer patients of various age group were randomly assigned to any of the two categories: preservation or sacrifice. Patients were then asked postoperatively to fill out a predesigned questionnaire to evaluate the studied items during hospitalization and after discharge.

Half of the included patients had their ICBN sacrificed, of which 18 (75 percent) developed numbness in the inner aspect of the arm. On the other end, only six of the 24 patients in the ICBN preservation group suffered numbness (25 percent; p=0.001).

The estimated duration of surgery was significantly shorter in the ICBN sacrifice group than in the ICBN preservation group (83.48±21.55 vs 100±22.02 minutes). But in terms of other variables of pain, seroma formation, need of simple analgesia and narcotics, hospital admission days, and arm swelling, no significant between-group difference was observed.