Serratus Anterior Plane Block for Awake Breast Surgery: A Case Report

Fascial plane blocks as the main anesthetic method: A narrative review

This narrative review evaluates the efficacy of fascial plane blocks (FPB) as sole anesthetic method for surgery. Particularly in selected high-risk patients, fascial plane blocks may be a more useful and convenient option than general anesthesia or neuraxial anesthesia. In recent years, with the use of ultrasound, newly defined FPBs have emerged and these techniques have become popular. There are case reports in the literature reporting the use of these blocks for anesthesia, but clinical studies are limited and clinicians may be undecided about which block or combination to apply in which case. In this narrative review, which is the first in this field in the literature, we aimed to discuss the use of FPBs and which combinations can be used in which incisions and which surgeries.

Combined thoracic paravertebral block and interscalene brachial plexus block for modified radical mastectomy: A case report

BACKGROUND

Modified radical mastectomy (MRM) is the most common surgical treatment for breast cancer. General anesthesia poses a challenge in fragile MRM patients, including cardiovascular instability, insufficient postoperative pain control, nausea and vomiting. Thoracic paravertebral block (TPVB) is adequate for simple mastectomy, but its combination with interscalene brachial plexus block (IBPB) has not yet been proved to be an effective anesthesia method for MRM.

CASE SUMMARY

We describe our experience of anesthesia and pain management in 10 patients with multiple comorbidities. An ultrasound-guided TPVB was placed at T2-T3 and T5-T6, and combined with IBPB, with administration of 10, 15 and 5 mL of 0.5% ropivacaine, respectively. A satisfactory anesthetic effect was proved by the absence of ipsilateral tactile sensation within 30 min. Propofol 3 mg/kg/h and oxygen supplementation via a nasal cannula were administered during surgery. None of the patients required additional narcotics, vasopressors, or conversion to general anesthesia. The maximum pain score was 2 on an 11-point numerical rating scale. Two patients required one dose of celecoxib 8 h postoperatively and none reported nausea or emesis.

CONCLUSION

This case series demonstrated that combined two-site TPVB and small-volume IBPB with sedation can be used as an alternative anesthetic modality for MRM, providing good postoperative analgesia.