Background and aims Anesthetic considerations for surgery during pregnancy include the safety of both mother and fetus. Surgical procedures and postoperative pain increase the potential risks of miscarriage and threatened premature labor. The erector spinae plane block (ESPB) is a novel paraspinal block first described for thoracic analgesia. Here, we report a case of successful anesthetic management for total mastectomy in a pregnant woman using general anesthesia combined with continuous ESPB.

Methods Written informed consent was obtained from the patient for presentation of this case. A 41-year-old woman was scheduled to undergo total mastectomy at 18 weeks of gestation. General anesthesia was induced and maintained with intravenous propofol, rocuronium, and remifentanil. After the induction of general anesthesia, we administered continuous ESPB. In detail, a total of 20 mL of 0.25% levobupivacaine was injected through the needle, followed by insertion of a 19-gauge catheter 5 cm beyond the needle tip. Then, infusion of 0.25% levobupivacaine was started at the rate of 6 mL/h.

Results After full recovery from general anesthesia, the patient was extubated and transferred to the general ward of the department of surgical oncology. At 2 hours after surgery, postoperative assessment of the fetus with Doppler ultrasound revealed no abnormalities. The patient did not need any additional analgesics during the postoperative period and was discharged home on the 15th day after surgery with no adverse effects on either mother or fetus.

Conclusions General anesthesia combined with continuous ESPB might be a safe anesthetic strategy for pregnant women undergoing total mastectomy.