Anesthesia for Breast Surgery

For breast sentinel node or axillary node surgery, your surgeon often will request a nerve block for anesthesia. When patients receive a nerve block for anesthesia, they often receive sedation during the surgery. But, they also may receive general anesthesia. The decision to have sedation or general anesthesia is based on the type of surgery and your medical issues.


The type of nerve block offered for breast and lymph node surgery is called a thoracic paravertebral nerve block.


What is a nerve block?


A nerve block means that numbing medicine is placed near nerves that provide feeling to a certain part of the body. For example, the dentist does a nerve block to numb your mouth for dental work.


What is a thoracic paravertebral nerve block?


A thoracic paravertebral block involves injecting numbing medicine in the space off to the side of your spine. The nerves that provide feeling to your chest wall, breast and axilla (arm pit) are located along your back, just below your neck. We most often use two or three injections to numb all the nerves that provide feeling to your chest wall.


What are the benefits of a nerve block?


By placing nerve blocks, we reduce the need for narcotic pain medicine during your surgery. This reduces the amount of time it takes you to wake up, and it decreases your risk for nausea and vomiting. A breathing tube and general anesthesia often are not needed. This decreases possible breathing problems. Research also shows that using nerve blocks for surgery speeds recovery time by several hours. As a rule, you will not need pain medicine for up to 12 hours after a nerve block because the surgery site remains numb.


What are the risks of a nerve block?


There is always risk to any medicine or procedure. In the case of thoracic paravertebral nerve blocks, the specific risks are:

  • Bleeding caused by the needle
  • Infection started by the needle
  • Nerve damage caused by the needle
  • Damage caused to your lung
  • Numbing spreads to the other side of your body (epidural spread)
  • For a time, you may have a droopy eyelid or weak arm

We take many steps to keep these blocks as safe as possible, including the use of ultrasound for placement of the injections, if possible. In most cases, the benefits outweigh the risks. We will discuss this with you on the day of surgery. These blocks have been done very successfully at this hospital for many patients who are having breast and lymph node surgery.