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We report a case of 50 years old female diagnosed with carci noma of breast posted for modified radical mastectomy (MRM). Her comorbidities included diabetes mellitus (DM), hypertension, ischemic heart disease (IHD) and chronic obstructive pulmonary disease (COPD). She was also anxious about postoperative analgesia. The surgery was successfully completed under general anesthesia (GA) with single level thoracic paravertebral block (PVB) using peripheral nerve stimulator (PNS). Regional techniques like PVB are preferred modalities for perioperative analgesia. It provides good intraoperative conditions with adequate postoperative analgesia with least hemodynamic alterations in high risk cases specially IHD.

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Introduction:The primary objective is to investigate the feasibility of proposed percutaneous ultrasound long axis (LA; in-plane) guided approach for celiac plexus neurolysis (CPN) in patients with advanced pancreatic cancer. The present study also aimed to assess the outcome as well as to document complications specific to the proposed technique if any. Materials and methods: Celiac plexus neurolysis under LA ultrasound (USG) guidance was performed in thirty one patients (mean age of 58.2 ± 4.7 years) of either-sex (24 men and 7 women) suffering from chronic pain due to pancreatic cancer [visual analog scale (VAS) score > 4] not responding to any pharmacological treatment or in those where opioids-related adverse effects are poorly tolerated. Follow-up was done immediately after injection, first day, 1 week, 4 weeks and 12 weeks following intervention and on an as needed basis thereafter. Post-neurolysis and at each subsequent follow-up visit, pain scores, satisfaction rate and other complications were studied. Level of statistical significance was set at a p < 0.05. Results: At 12 weeks CPN under LA ultrasound guidance was associated with significant pain relief, reduced NSAIDS/opioids consumption and improved patient satisfaction (p < 0.05). There were no major peri-and/or postoperative complications. Conclusion: Celiac plexus neurolysis under LA USG guidance enhances effectiveness and was associated with better pain relief, reduced NSAIDS/ opioids consumption and improved patient satisfaction. Clinical significance: Celiac plexus neurolysis under LA USG guidance enhances effectiveness of pain relief and level of safety in patients with abdominal malignancies.