Segmental Thoracic Spinal Anaesthesia for Modified Radical Mastectomy in a Bronchiectasis Patient

Madishetti, Eeshwar Rao; Aasim, Syed Ali; Bethi, Ravindar

doi:10.21088/ijaa.2349.8471.42(pt-ii)17.31

Cited by 4 publications

(4 citation statements)

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“…The above literature supports our decision to puncture the dura and perform sub arachnoid block at higher thoracic space. Madishetti gave segmental thoracic anesthesia to a patient with bronchiectasis with 1 ml 0.5% Bupivacaine heavy and 20 mcg Fentanyl in T5-T6 Space using the Quincke Babcock needle and the procedure was conducted successfully [9]. Lee et al measured medial sagittal slices of the thoracic and lumbar region with the help of magnetic resonance imaging in 19 patients.…”

Section: Discussionmentioning

confidence: 99%

A Prospective Observational Study on the Effectiveness of Segmental Spinal Anesthesia in Patients Posted for Modified Radical Mastectomies

2023

Ann Case Report

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Background: Modified radical mastectomy is a treatment of choice in patients having carcinoma breast. The higher chances of complications with general anesthesia lead to a change in our clinical practice towards regional anesthesia. The current literature revealed that the maximum distance between the dura mater and the spinal cord is at the mid-thoracic level, but very few studies are advocating for the use of segmental spinal anesthesia for modified radical mastectomies. Therefore, the present study is planned to assess the effectiveness of segmental spinal anesthesia in patients posted for modified radical mastectomies. Material and Methods:The present study was conducted at a tertiary care centre between April 2020 to November 2022 after approval by the institute's ethical and research committee. The study recruited 78 patients aged between 20-70 years with American Society of Anesthesiologists (ASA) physical status I-III who were scheduled for modified radical mastectomy with axillary dissection. A subarachnoid block was performed at T5-T6 or T6-T7 levels with 27 G Quincke Babcock needle using a midline approach with a 45° tilt of the needle in all the patients under aseptic precautions after. Once the free flow of Cerebrospinal fluid (CSF) was confirmed, 1.5 ml isobaric levobupivacaine with 5 mcg of Dexmedetomidine was administered. Results:In the present study, 97% of the surgeons were satisfied with the procedure. All the patients had stable hemodynamics and adequate sensory and motor blockade. A single episode of hypotension was noted in 9% percent of the patients and 6% of them had bradycardia once during the procedure. However, the alterations in hemodynamics were successfully managed during the procedure. Paresthesia was found during needle insertion in 4% of patients, but none of them had any neurological damage. Conclusion:Segmental spinal anesthesia is a safe alternative to general anesthesia in cases of carcinoma breast undergoing modified radical mastectomy.

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Section: Discussionmentioning

confidence: 99%

A Prospective Observational Study on the Effectiveness of Segmental Spinal Anesthesia in Patients Posted for Modified Radical Mastectomies

2023

Ann Case Report

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“…In many published literature, plain bupivacaine was used for thoracic segmental block 1,2,3,10 . Madishetti successfully conducted segmental thoracic anesthesia to a patient with bronchiectasis with 1 ml 0.5% Bupivacaine heavy and 20 mcg Fentanyl in T5-T6 Space using the Quincke Babcock needle 20 . Heisnam et al also performed segmental spinal anaesthesia with heavy bupivacaine at T10-T11 interspace for laparoscopic cholecystectomy 21 .…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Segmental Thoracic Spinal Anaesthesia in Breast Surgery: An Observational Study

Ullah,

Kamal,

Begum

et al. 2024

J Shaheed Suhrawardy Med Coll

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Background: General anaesthesia is usually performed for breast surgery but the risks and complications of general anaesthesia outweigh its benefits. For this, segmental thoracic spinal anesthesia might be an alternative to general anesthesia. Objectives: The objective of this study was to evaluate the effectiveness segmental thoracic spinal anaesthesia in breast surgery. Methods: This prospective observational study was conducted at surgery operation theatre in the Shaheed Suhrawardy Medical College and Hospital, Dhaka, Bangladesh from January 2023 to December 2023. Patients of ASA (American Society of Anesthesiologist) class I and II, ageing above 18 years, and BMI < 35 kg/m2 scheduled for breast surgery (modified radical mastectomy for carcinoma breast, lumpectomy for breast lump/gynaecomastia, and wide local excision for phylloids tumor) were included in this study. Segmental thoracic spinal anaesthesia was performed at T5-T6 space with injection 0.5% hyperbaric bupivacaine 1 ml (5mg) and fentanyl 0.5 ml (25 microgram). Perioperative hemodynamic changes, unwanted effects, time of first rescue analgesic, total opioid consumption in first 24 h, patient and surgeon satisfaction score were recorded in a data sheet. Results: Sixty patients were eligible for the study but 55 patients completed the study successfully. Modified radical mastectomy, Lumpectomy and Wide local excision were done in 42 (76%), 8 (15%) and 5 (9%) patients, respectively. The mean age of the patients was 50.78±8.98 years. There were no significant changes in haemodynamic parameters during the intraoperative period. The frequency of adverse effects were minimal. Mean time for 1st dose of analgesic was 5.8±1.8 hours and total opioid consumption was 76.77±15.7 mg in first 24 hours. Both patient (91%) and surgeon (95%) were highly satisfied with this technique. Conclusions: Segmental thoracic spinal anaesthesia provides better satisfaction and fewer complications in patients undergoing breast surgery. This regional anaesthesia technique can be used effectively for breast surgeries. J Shaheed Suhrawardy Med Coll 2022; 14(2): 47-52

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“…Zundert et al, 7 also used TSS successfully for laparoscopic cholecystectomy in patients with severe lung diseases. Madishetti et al, 8 even used it for mastectomy.…”

Section: Discussionmentioning

confidence: 99%

Thoracic segmental spinal anaesthesia for laparoscopic cholecystectomy in a case of birt-hogg-dube syndrome

Ghosh

Roy

2023

Asian J Med Sci

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Birt-Hogg-Dube syndrome is an extremely rare genetic disorder featuring multiple lung cyst or bulla which lead to recurrent spontaneous pneumothorax. Laparoscopic cholecystectomy poses a significant challenge in such cases from anesthetic point of view. Thoracic segmental spinal anesthesia (TSS) is a relatively new and beneficial alternative to general anesthesia to avoid post-operative complications. In this report, we used thoracic segmental spinal successfully in a known case of Birt-Hogg-Dube syndrome to avoid post-operative pneumothorax and discussed the technique and anatomical and physiological consequences. We can conclude that thoracic segmental spinal anesthesia can be used safely and successfully in laparoscopic cholecystectomy specially in cases where general anesthesia is better avoided as in Birt-Hogg-Dube syndrome.

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Segmental Thoracic Spinal Anaesthesia for Modified Radical Mastectomy in a Bronchiectasis Patient

Cited by 4 publications

References 0 publications

A Prospective Observational Study on the Effectiveness of Segmental Spinal Anesthesia in Patients Posted for Modified Radical Mastectomies

A Prospective Observational Study on the Effectiveness of Segmental Spinal Anesthesia in Patients Posted for Modified Radical Mastectomies

Effectiveness of Segmental Thoracic Spinal Anaesthesia in Breast Surgery: An Observational Study

Thoracic segmental spinal anaesthesia for laparoscopic cholecystectomy in a case of birt-hogg-dube syndrome

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