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Background and Aims Mastectomy procedures often lead to significant postoperative pain, raising the risk of chronic pain development in women undergoing breast surgery. Loco-regional anaesthesia techniques aim to alleviate postoperative pain and reduce the need for perioperative opioids.

Methods This case study exemplifies the use of thoracic paravertebral block (TPVB) for effective postoperative pain management in a patient undergoing surgical breast surgery with a latissimus dorsi pedicled graft for breast reconstruction.

Results A 48-year-old woman, ASA-II, with antiphospholipid syndrome and fibromyalgia, presented with locally advanced breast cancer recurrence following a previous mastectomy was scheduled for radical mastectomy and reconstruction using a pedicled graft with latissimus dorsi muscle. Before surgery, a left ultrasound-guided TPVB was performed at the T4-T5 level, administering a single-shot of 20mL of 0.375% Ropivacaine. General anaesthesia was induced, supplemented with 50µg of fentanyl. In an effort to minimize opioid usage, intraoperative analgesia included 1000mg of paracetamol, 30mg of ketorolac, 100mg of tramadol and 30mg of ketamine. No opioid besides induction was used. Surgery and anaesthetic emergency were uneventful. In the post-anaesthesia care unit (PACU), the patient remained hemodynamically stable and painless without any additional opioid medication for three hours. No complications were registered. Patient remained two days in hospital with controlled pain with scheduled intravenous paracetamol and ketorolac without any opioid consumption, until discharge.

Conclusions The patient‘s stable hemodynamic profile, absence of postoperative pain and minimal requirement for rescue analgesics, mainly opioids, highlights the benefits of TPVB as a viable analgesic opioid sparing approach for major breast surgery.