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Background and Aims While MRM is typically performed under GA, regional analgesia might lower the cardiovascular and respiratory complications in high-risk patients. In this case report, we present a 40-year-old female who had an anaphylactic shock and underwent 6 cycles of CPR following cefuroxime AST, EF of 45% and chronic bronchitis. Despite these challenges, she successfully underwent MRM for stage 3b breast carcinoma.

Methods After obtaining high risk consent and two large bore IV cannulas and standard monitors, USG guided right PVB at T2-T3, T3-T4 level was administered. She was induced with fentanyl and propofol and pro-seal LMA was placed. Muscle relaxant was not given. Propofol TIVA was started at 250mg/hr. Post induction, USG guided right SAPB was given at 4th and 5th ribs.

Hemodynamic stability was achieved Muscle relaxant necessity was not present. Opioid requirement was nil intra-operatively and postoperatively. She was pain-free in the post-operative period.

Conclusions Thus, combined thoracic PVB with SAPB along with TIVA is an alternative anesthetic modality for MRM surgeries. It avoided perioperative anaphylaxis, provided stable hemodynamic, post operative analgesia for a patient having multiple cardio-respiratory co-morbidities.