Background and Aims Mastectomy is frequently performed under general anaesthesia (GA)1. Occasionally, regional anaesthesia has been described as the sole anaesthetic technique. We aim to present a female with congenital muscular dystrophy (CMD) undergoing modified radical mastectomy (MRM) and axillary dissection (AD) with an anaesthetic thoracic epidural.
Methods A 75-year-old female with a history of CMD and flaccid tetraparesis with severe respiratory involvement was scheduled for MRM with AD due to cancer. An epidural catheter was inserted 5cm cephalad in the T4/T5 interspace. A test dose was administered followed by a 7 mL bolus of 0.5% ropivacaine and 1mg morphine. BIS-guided sedation with propofol target-controlled infusion was performed. Surgery was uneventful. She was transferred to the PACU for monitoring and was discharged without complications.
Results Patients with CMD represent high-risk surgical candidates. Rhabdomyolysis and respiratory failure are concerns with GA2. Anaesthesia of the breast is possible with nerve blocks and thoracic epidural1. Due to its complex innervation, multiple blocks must be combined to achieve complete anaesthesia of the breast3. Additionally, sonoanatomy may be altered in CMD, increasing technique difficulty and failure rates4. Thoracic epidural was performed due to our superior experience. Advantages include surgical stress attenuation, postoperative analgesia and prompt recovery1. The catheter would also allow local anesthetic top-ups.
Conclusions Although CMD is challenging, alternatives to GA are possible for mastectomy. Thoracic epidural allows maintenance of spontaneous ventilation, provides adequate surgical anaesthesia and postoperative analgesia, representing a suitable option for patients with myopathy presenting for mastectomy.
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