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Abstract
Background and Aims We report a case of an 87-year-old female patient, ASA 3, with significant comorbidities who underwent awake right breast lumpectomy under anterior serratus plane block (ASPB), because of her high risk for general anaesthesia. Following a right total mastectomy 3 years ago, she presented with cancer recurrence; the lump was located close to the lateral aspect of previous mastectomy scar and close to axilla. The superficial ASPB was chosen because it blocks the nerves that innervate the lateral half of breast and the axilla.1
Methods Written informed consent was obtained by the patient for publication. The block was performed at the level of the fifth rib at the anterior axillary line with the patient supine. An ultrasound-guided in plane transverse approach was used. A total of 30 ml ropivacaine 0.5% was administered in incremental boluses at the plane between the serratus anterior and the latissimus dorsi (figure 1). The patient was mildly sedated intraoperatively with 75 mcg Fentanyl and 60 mcg Clonidine and tolerated the procedure well.
Results Procedure and recovery were uneventful. She did not complain of any pain and she did not require any painkillers for the next 24 hours following the block. Her pain thereafter was controlled with rescue Paracetamol.
Conclusions Awake breast surgery under ASPB as single block technique is feasible when the surgery is limited to the lateral half of the breast and the axilla. Understanding the anatomy of the surgical technique is important to decide between the various regional techniques available for breast surgery.