{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T05:58:03Z","timestamp":1777874283452,"version":"3.51.4"},"reference-count":21,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2024,10,25]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Innervation of the breast includes branches of thoracic intercostal nerves, the superficial cervical plexus, the brachial plexus, and the intercostobrachial nerve (ICBN). Commonly used blocks for breast surgery provide incomplete analgesia of the axillary region. This cadaveric study aims to identify and map the axillary sensory cutaneous nerves.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted nine axillary dissections on cadavers of both sexes with cadavers in supine position and upper limbs abducted. Incisions along the anterolateral thorax and superior clavicle created laterally reflecting skin flaps, allowing visualization of the ICBN and brachial plexus. Photographs were taken during dissections to enabled three-dimensional reconstruction using imaging software 3D Slicer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In all dissections, an ICBN and a branch of the posterior cord were identified entering axillary subcutaneous tissue. A branch of the medial cord was identified entering axillary tissue in 5\/9 (56%) cadavers. The ICBN remained localized to the anterior axillary base but demonstrated various extrathoracic branching patterns. The posterior cord branch arose from the proximal posterior cord before penetrating the axillary base at its posterior margin in all cadavers. When present, the medial cord branch arose from the proximal medial cord before penetrating the axillary base along the midaxillary line.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In addition to the ICBN, two branches of the brachial plexus were identified entering axillary subcutaneous tissue. These branches are not currently considered when providing analgesia for breast surgery and may contribute to pain following surgery that involves axillary dissection.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rapm-2024-106061","type":"journal-article","created":{"date-parts":[[2024,12,31]],"date-time":"2024-12-31T11:10:15Z","timestamp":1735643415000},"page":"454-459","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Mapping axillary sensory cutaneous nerves for enhanced analgesic approaches in axillary surgery: a cadaveric study"],"prefix":"10.1136","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-2255-2687","authenticated-orcid":false,"given":"Brittany","family":"Zurkan","sequence":"first","affiliation":[{"name":"Department of Anatomy and Cell Biology, University of Western Ontario, London, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7102-2491","authenticated-orcid":false,"given":"Timothy D","family":"Wilson","sequence":"additional","affiliation":[{"name":"Department of Anatomy and Cell Biology, University of Western Ontario, London, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6352-7844","authenticated-orcid":false,"given":"Abhijit","family":"Biswas","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Perioperative Medicine, University of Western Ontario, London, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,12,31]]},"reference":[{"key":"2026043012300840000_51.4.454.1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21660"},{"key":"2026043012300840000_51.4.454.2","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1001\/jamaoncol.2022.7826","article-title":"Estimates and Projections of the Global Economic Cost of 29 Cancers in 204 Countries and Territories From 2020 to 2050","volume":"9","author":"Chen","year":"2023","journal-title":"JAMA Oncol"},{"key":"2026043012300840000_51.4.454.3","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.19323"},{"key":"2026043012300840000_51.4.454.4","doi-asserted-by":"crossref","first-page":"1233","DOI":"10.3892\/ol.2015.3486","article-title":"Breast cancer metastasis and the lymphatic system","volume":"10","author":"Rahman","year":"2015","journal-title":"Oncol Lett"},{"key":"2026043012300840000_51.4.454.5","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.mpsur.2021.11.015","article-title":"Anatomy and physiology of the breast","volume":"40","author":"Bazira","year":"2022","journal-title":"Surg (Oxford)"},{"key":"2026043012300840000_51.4.454.6","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1111\/jmwh.13012","article-title":"Long\u2010Term Effects of Breast Cancer Surgery, Treatment, and Survivor Care","volume":"64","author":"Lovelace","year":"2019","journal-title":"J Midwife Womens Health"},{"key":"2026043012300840000_51.4.454.7","doi-asserted-by":"publisher","DOI":"10.1097\/AAP.0000000000000801"},{"key":"2026043012300840000_51.4.454.8","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1007\/s12630-021-02183-z","article-title":"Efficacy of regional anesthesia techniques for postoperative analgesia in patients undergoing major oncologic breast surgeries: a systematic review and network meta-analysis of randomized controlled trials","volume":"69","author":"Singh","year":"2022","journal-title":"Can J Anesth\/J Can Anesth"},{"key":"2026043012300840000_51.4.454.9","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2009.1568"},{"key":"2026043012300840000_51.4.454.10","unstructured":"The Slicer Community . 3D Slicer image computing platform, Available: https:\/\/www.slicer.org\/"},{"key":"2026043012300840000_51.4.454.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.mri.2012.05.001"},{"key":"2026043012300840000_51.4.454.12","doi-asserted-by":"crossref","first-page":"W28","DOI":"10.1097\/RTI.0000000000000639","article-title":"Axillary Anatomy and Pathology: Pearls and \u201cPitfalls\u201d for Thoracic Imagers","volume":"37","author":"Stowell","year":"2022","journal-title":"J Thorac Imaging"},{"key":"2026043012300840000_51.4.454.13","article-title":"From Cadaveric Dissection to the Operating Room: A Unilateral Double Intercostobrachial Nerve and the Implications in Axillary Lymph Node Dissection","volume":"15","author":"Olivencia-Delgado","year":"2023","journal-title":"Cureus"},{"key":"2026043012300840000_51.4.454.14","doi-asserted-by":"publisher","DOI":"10.1046\/j.1440-1622.1999.01718.x"},{"key":"2026043012300840000_51.4.454.15","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1002\/ca.20226","article-title":"The gross anatomy of the extrathoracic course of the intercostobrachial nerve","volume":"19","author":"Loukas","year":"2006","journal-title":"Clin Anat"},{"key":"2026043012300840000_51.4.454.16","doi-asserted-by":"publisher","DOI":"10.1016\/S0749-0712(03)00088-X"},{"key":"2026043012300840000_51.4.454.17","doi-asserted-by":"publisher","DOI":"10.1136\/rapm-2019-100689"},{"key":"2026043012300840000_51.4.454.18","doi-asserted-by":"publisher","DOI":"10.1136\/rapm-2018-100298"},{"key":"2026043012300840000_51.4.454.19","doi-asserted-by":"publisher","DOI":"10.1136\/rapm-2020-101317"},{"key":"2026043012300840000_51.4.454.20","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1016\/j.morpho.2021.06.003","article-title":"An uncommon, unilateral motor variation of the intercostobrachial nerve","volume":"106","author":"van Tonder","year":"2022","journal-title":"Morphologie"},{"key":"2026043012300840000_51.4.454.21","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1111\/anae.15276","article-title":"Ultrasound-guided fascial plane blocks of the chest wall","volume":"76","author":"Chin","year":"2021","journal-title":"Anaesthesia"}],"container-title":["Regional Anesthesia &amp; Pain Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/rapm-2024-106061","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T19:30:55Z","timestamp":1777577455000},"score":1,"resource":{"primary":{"URL":"https:\/\/rapm.bmj.com\/lookup\/doi\/10.1136\/rapm-2024-106061"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,31]]},"references-count":21,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4,2]]},"published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1136\/rapm-2024-106061"],"URL":"https:\/\/doi.org\/10.1136\/rapm-2024-106061","relation":{},"ISSN":["1098-7339","1532-8651"],"issn-type":[{"value":"1098-7339","type":"print"},{"value":"1532-8651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,31]]}}}