A cadaver study to determine the minimum volume of methylene blue or black naphthol required to completely color the nerves relevant for anesthesia during breast surgery
Bibliographic record
Abstract
Regional anesthesia for breast surgery may require a large amount of local anesthetic solution to provide an adequate blockade of all relevant structures. The purpose of this study was to determine the minimal volume of fluid required to anesthetize all nerves to adequately provide anesthesia for breast surgery. This is an open randomized study. Cadavers were embalmed using Thiel's technique and were injected with different volumes of 0.2% methylene blue or 0.2% black naphthol for a superficial cervical plexus block (2, 5, 10, or 15 mL), an interscalene block (5, 10, 15, or 20 mL), paravertebral blocks from C(8) to T(6), and intercostal nerve blocks at 8 cm from the midline (2 or 3 mL) under ultrasound-guided or assisted techniques. The following minimal volumes of fluid were required for complete coloration of the nerves: 2 mL for the supraclavicular nerves; 20 mL for the nerve roots from C(5) to C(7), inclusive, if intraneural injection was avoided; 3 mL per root for the nerve roots from C(8) to T(6), inclusive, for a paravertebral block; and 2 mL per nerve for intercostal nerve blocks at T(4) and lower. With 20 mL of solution at the interscalene level, the roots of C(3) and C(4) were also colored; therefore, a separate injection for the supraclavicular nerves was unnecessary. We conclude that regional anesthesia for complex breast surgery can be achieved with a volume of local anesthetic as low as 41 mL.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.010 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".