Single Needle Thoracic Paravertebral Block with Ropivacaine and Dexmeditomidine for Radical Mastectomy: Experience in 25 Cases

Abstract

Background: Currently regional technique like thoracic paravertebral block for breast surgery is gaining a lot of popularity. As it produces unilateral action thereby minimal hemodynamic changes with autonomic blockade, allows early ambulation, facilitates postoperative analgesia, eliminate the risks/complications of general anaesthesia and thus reduces the hospital stay and cost.

Anatomic Landmark Technique Thoracic Paravertebral Nerve Block as a Sole Anesthesia for Modified Radical Mastectomy in a Resource-Poor Setting: A Clinical Case Report

“…Furthermore, it is associated with minimal hemodynamic instability, early discharge from hospital with reduced cost of the treatment. 5 In almost all of these cases, the block was performed under ultrasound guidance which benefits of direct visualization of the needle, local anesthetic (LA) spread and the pleura. Besides, in some of the cases, a continuous epidural catheter was inserted into the paravertebral space.…”

“…Furthermore, studies also suggested that TPVB attenuates perioperative immunosuppression and decrease cancer metastasis. 1 , 5 …”

“…Ultrasound-guided TPVB has shown that it is a promising option for mastectomy in providing a comfortable surgical field. 5 Implementing regional anesthesia techniques like a paravertebral block for patients with metastasis features of cancer to lungs and other organs, patients with co-morbidity, geriatrics, and malnourished individuals eliminate the risks and complications of GA and decreases patient morbidity and mortality. Also, it has the advantage of a better hemodynamic profile, early ambulation, and shorter hospital stay.…”

“…Though TPVB is an established technique as postoperative pain management for breast surgery, there is no conclusive evidence on its use as sole surgical anesthesia for modified radical mastectomy. 5 , 8 , 9 In this report, we present perioperative management of a patient with breast cancer with evidence of metastasis to the lungs, and who had undergone a modified radical mastectomy (MRM) under TPVB using an anatomic landmark multiple injection technique as sole intraoperative anesthesia. This report adheres to the applicable CARE checklist.…”

Management of Radical Mastectomy under Sole Thoracic Paravertebral Block in a 92 years Old Patient with CardioPulmonary Dysfunction

“…Thoracic paravertebral space contains dorsal and ventral rami of spinal nerves, sympathetic chain where injection of local anaesthetic is made that produces unilateral sympathetic, sensory and motor blockade [2,3]. We conducted a study on sole TPVB for radical breast surgeries in 25 ASA grade I-III patients and found it is very safe and useful method [4]. We intend to report a recent high risk case of 92 years old lady with compromised cardiopulmonary function who underwent radical mastectomy under sole TPVB successfully.…”