Background and Aims Regional anestesia (RA) is a valuable alternative to general anesthesia (GA) in breast cancer surgery (BCS). In vitro studies suggest that RA might positively influence cancer outcome (1). We present a documented difficult airway case of a 80-year-old woman, proposed for lumpectomy under Interpectoral block (IPB) and Pecto-Intercostal Fascial Block (PIFB).
Methods A 80 year-old woman suffering from a non-controled severe obstructive sleep apnea, obesity (BMI 34) with a breast papilar carcinoma was proposed for lumpectomy (23×11 mm lesion at the internal quadrants).
Results She presented a IV Mallampati score (figure 1), thyromental distance < 6cm, class II upper-lip-bite test and previous history of difficult airway management with postponement of this procedure 3 days before. After patient’s consent, we succefully managed the case with an ultrasound-guided IPB and a PIFB (figure 2), total local anaesthetic solution – 20 mL of mepivacaine 1,5% & ropivacaine 0,375% under light sedation. The procedure was uneventful, for patient and surgical team.
Conclusions IPB and PIFB successfully managed anaesthesia & analgesia of this case under light sedation, avoiding GA and management of a documented difficult airway patient. Latest evidence supports IPB as a good technique for BCS(2) and PIFB is a relatively novel block suited for inner quadrant breast surgery approach(3). RA has been a good alternative avoiding airway management on this documented difficult airway, provided excellent surgery conditions, pain relief and a high level of patient satisfaction.
Approval has been granted by the ethics committee
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