• Breast surgery
    • Risks for Ca
      • Age
      • Early menarche, late menopause
      • Age at 1st pregnancy
      • FHx
      • RXT
      • COCP
      • BRCA1/2/p53
    • No specific pre-op tests but may need FBC if been on chemotherapy, G&S.
      • High risk of PONV
    • Structure
      • Arterial supply
        • Axillary, intercostals (T1-5), internal mammary artery
      • Venous drainage
        • Superficial and deep (drain into azygous and vertebral veins)
      • Lymphatic drainage
        • Axiliary nodes
        • Internal mammary nodes
    • Regional options
      • Paravertebral block
      • Thoracic epidural
      • Multiple intercostal blocks
      • Intra pleural block
      • Advantages
        • Reduced PONV
        • Opiate avoidance
        • Superior analgesia
        • Reduced stress response
        • Earlier mobilisation
      • Disadvantages
        • CI with local infection
        • Failure
        • LA toxicity
        • Pneumothorax
        • Bleeding risk
        • Dural puncture
        • Hypotension
        • Urinary retention
    • CEACCP
      Link:ceaccp.oxfordjournals.org/content/3/5/151.full.pdf