Introduction: Quadrantectomy is a surgical procedure traditionally performed under general anaesthesia with intraoperative and postoperative opioid-based analgesia. The use of locoregional anaesthesia techniques in breast surgery has become widespread and allows excellent management of intraoperative and postoperative pain with reduced opioid consumption. We chose thoracic paravertebral block as regional anaesthesia technique in breast surgery to investigate the possibility of carrying out this surgery with the patient awake. Methods: A prospective observational study on 50 patients was designed. The primary outcome for this study was the possibility to carry out the surgery with only the paravertebral block associated with mild sedation without general anaesthesia. Forty minutes before the start of the surgery, an ultrasound-guided thoracic paravertebral block was performed at two thoracic levels, and for each level, 7 mL of ropivacaine 0.7% was injected. Sedation was obtained with target-controlled infusion of propofol. Results: Forty-nine patients underwent the operation awake; in one case, we had to place an I-gel and perform general anaesthesia. No patient needed intraoperative or postoperative opioids. The numeric rating scale, recorded at 0, 2, 6, 12, 24, and 36 hours, was greater than 3 in only five patients. Conclusions: Quadrantectomy with exclusively regional anaesthesia and thoracic paravertebral block can be performed with the patient awake and collaborating.
These cases suggest that stuck valve could occur not only for mechanical valves but also for bioprosthetic valves. Significant transvalvular regurgitation could be seen without apparent obstruction by residual tissue or inappropriate suture looping. Thus, anesthesiologists should be aware of this possible dysfunction of newly implanted valves. Implanted valve function should be evaluated routinely by TEE investigation before CPB discontinuation. Conflict of Interest K. Takahashi had a consulting agreement with Edwards Lifesciences in 2019.
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