Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 16, 2022; 10(17): 5741-5747
Published online Jun 16, 2022. 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, Guang Sun, Shen-Tong Wang, Kai Li
Zhou-Ting Hu, Shen-Tong Wang, Kai Li, Department of Anesthesia, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
Guang Sun, Department of Breast Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
Author contributions: Li K was the patients’ anesthetist; Sun G was the patients’ surgeon; Li K reviewed the literature and contributed to study conception and design, acquisition, analysis and interpretation of data, drafting the article, revising it critically for important intellectual content; Hu ZT and Wang ST were contributed to follow-up, acquisition, revising the article critically for important intellectual content; all authors have read and approved the final manuscript, and agreed to be accountable for all aspects of the work.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kai Li, MD, Assistant Professor, Doctor, Department of Anesthesia, China-Japan Union Hospital of Jilin University, No. 126 Xiantai Avenue, Changchun 130033, Jilin Province, China. likai@jlu.edu.cn
Received: October 28, 2021
Peer-review started: October 28, 2021
First decision: December 27, 2021
Revised: January 14, 2022
Accepted: April 4, 2022
Article in press: April 4, 2022
Published online: June 16, 2022
Processing time: 223 Days and 17.4 Hours
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: Modified radical mastectomy; Paravertebral block; Brachial plexus block; Sedation; Case report

Core Tip: Thoracic paravertebral block (TPVB) has been proved to be adequate for simple mastectomy. However, TPVB combined with interscalene brachial plexus block (IBPB) has not yet been proved to be an effective anesthesia method for modified radical mastectomy (MRM). 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, which avoids the potential risks of general anesthesia and phrenic nerve paralysis especially in frail patients with multiple comorbidities, and provides extended postoperative analgesia.