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206 Pectoral nerve and parasternal block combination in breast cancer surgery: subcutaneous mastectomy with reconstruction under regional anesthesia and sedation. A case study
  1. F Marrone,
  2. S Paventi,
  3. M Tomei and
  4. M Bosco
  1. ASL ROMA 1 – Ospedale Santo Spirito, Roma, Italy


Background and Aims US-guided pectoral nerve block may provide anaesthesia of lateral area of thorax, dermatomes T2-T6. US-guided parasternal block may provide anaesthesia of medial area of breast. A combination of these blocks and sedation may be used in mastectomy especially in high risk patients.

Methods Patient aged-70, BMI 20; breast cancer (5cm triple-negative Ki50%). Primary chemioterapy. Internal jugular vein thrombosis. Hypertension. Smoking. Anemia. ASA3. Subcutaneous mastectomy, sentinel lymph-node biopsy, reconstruction. After valid informed consent, anatomy and needle’s tip correctly viewed, aseptically, US-PECS2 block was performed, 80-mm echogenic needle; 0.5% ropivacaine 20 ml were injected. US-PsB, second-fourth intercostal spaces, was performed; 50-mm needle; 0.375% ropivacaine 4 ml injected for each block. No complications. Pneumothorax excluded by LUS. Patient received IV midazolam 2 mg + fentanyl 50mcg; ketamine initial bolus 30 mg (0,5 mg/kg) then boluses, 90 mg in 2 hours, to induce and maintain light sleep with arousability. IV lydocaine 40 mg, clonidine 75mcg, dexamethasone 8 mg at beginning of surgery. IV lydocaine 2% 1 ml h-1 was provided for 2 hours after initial bolus. Acetaminophen 1g before awake. Spontaneous breathing and supplemental oxygen 40%.

Results Monitored Anesthesia Care (MAC) was provided. Surgery began 15 minutes after MAC, 30 minutes after blockades placement. Surgery lasted 145 minutes, patient vital signs stable. No supplemental opioids or additional local anesthetics required during surgery. No pain (movement/rest). No morphine required. No peri-operative complications recorded.

Conclusions We performed US-guided inter-fascial plane blocks with high efficacy and safety. Our patient was successfully surgically treated. Regional anesthesia allowed early recovery, reduced postoperative opioid/non-opioid analgesics consumption together with early home discharge and cost reduction.

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