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Case Reports
. 2022 Jun 16;10(17):5741-5747.
doi: 10.12998/wjcc.v10.i17.5741.

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

Zhou-Ting Hu  1 , Guang Sun  2 , Shen-Tong Wang  1 , Kai Li  3
Affiliations
Case Reports

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

Zhou-Ting Hu et al. World J Clin Cases. .

Abstract

Background: Modified 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 summary: We 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.

Conclusion: This 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.

Keywords: Brachial plexus block; Case report; Modified radical mastectomy; Paravertebral block; Sedation.

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Conflict of interest statement

Conflict-of-interest statement: The authors declare that they have no conflict of interest.

Figures

Figure 1
Figure 1
Ultrasound image of the paravertebral block. Tm: Trapezius muscle; Rm: Rhomboideus muscle; ESm: Erector spinal muscle; TP: Transverse process; SCTL: Superior costotransverse ligament; LA: Local anesthesia agency; P: Pleura.
See this image and copyright information in PMC

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