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Background and Aims Myastania gravis, is a rare autoimmune neuromuscular disease, characterized by auto antibodies to the acetylcholine receptor causing weakness and fatigue in the limb and respiratory muscles. With patient consent and permission, we present a case 24 year old female scheduled for a partial thymectomy via thoracotomy using multimodal postoperative analgesia strategies.

Methods A 24-year-old woman (height 158 cm; weight 49 kg; American Society of Anesthesiologists physical status II) was scheduled for a partial thymectomy via thoracotomy. Preoperatively intravenous immunglobulin was administered and taking routine medication of pyridostigmine. After induction using 150 mg of IV propofol and 0.5 μg/kg remifentanyl, 20 mg rocuronium, the remaining 3 h of general anesthesia using sevoflurane, infusion of remifentanyl without adding muscle relaxant. No need for reversal of the muscle relaxant, extubated successfully. Patient did not accept the thoracic epidural catheter insertion preoperatively. At the end of the surgery, 22-G needle was inserted between the latissimus dorsi and the serratus anterior muscles at the fifth rib midaxillary line and a total of 30 ml of bupivacaine 0.25% was injected with ultrasound guidance. Paracetamol administered at 6-hour intervals, the patient was followed up in the intensive care unit for 16 hours after the operation was taken to the ward.

Results No complications were encountered, and patient demonstrated high level of satisfaction. Rapid and safe recovery was achieved in this patient with myastania gravis.

Conclusions Single injection of serratus anterior plane block seems to be a safe and effective for the management of acute postoperative pain after thoracotomy avoiding opioids.