Combined thoracic paravertebral block and interscalene brachial plexus block for modified radical mastectomy: A case report.

Content Provider	Europe PMC
Author	Hu, Zhou-Ting Sun, Guang Wang, Shen-Tong Li, Kai
Copyright Year	2022
Abstract	BACKGROUNDModified radical mastectomy (MRM) is the most common surgical treatment for breast cancer. General anesthesia poses a challenge in fragile MRM patients, including cardiovascular instability, insufficient postoperative pain control, nausea and vomiting. Thoracic paravertebral block (TPVB) is adequate for simple mastectomy, but its combination with interscalene brachial plexus block (IBPB) has not yet been proved to be an effective anesthesia method for MRM.CASE SUMMARYWe describe our experience of anesthesia and pain management in 10 patients with multiple comorbidities. An ultrasound-guided TPVB was placed at T2-T3 and T5-T6, and combined with IBPB, with administration of 10, 15 and 5 mL of 0.5% ropivacaine, respectively. A satisfactory anesthetic effect was proved by the absence of ipsilateral tactile sensation within 30 min. Propofol 3 mg/kg/h and oxygen supplementation via a nasal cannula were administered during surgery. None of the patients required additional narcotics, vasopressors, or conversion to general anesthesia. The maximum pain score was 2 on an 11-point numerical rating scale. Two patients required one dose of celecoxib 8 h postoperatively and none reported nausea or emesis. CONCLUSIONThis case series demonstrated that combined two-site TPVB and small-volume IBPB with sedation can be used as an alternative anesthetic modality for MRM, providing good postoperative analgesia.
Volume Number	10
PubMed Central reference number	PMC9258351
Issue Number	17
PubMed reference number	35979098
Journal	World Journal of Clinical Cases
e-ISSN	23078960
DOI	10.12998/wjcc.v10.i17.5741
Language	English
Publisher	Baishideng Publishing Group Inc
Publisher Date	2022-06-01
Access Restriction	Open
Rights License	This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/ ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Subject Keyword	Modified radical mastectomy Paravertebral block Brachial plexus block Sedation Case report
Content Type	Text
Resource Type	Article
Subject	Medicine