Ultrasound-guided fascial plane blocks as unique anesthetic technique for total mastectomy in a covid-19 era: A case report

Abstract

Introduction Regional anesthesia techniques were recently introduced to provide analgesia for breast surgery. These techniques are rarely used as the primary anesthesia due to the complexity of breast innervation, with numerous structures that can potentially be disrupted during breast surgery. Case report A female patient in her sixties diagnosed with invasive ductal carcinoma on her left breast was scheduled for a simple mastectomy. After anesthetic evaluation, identification of high risk perioperative cardiovascular complications, it was proposed to perform the surgery only with regional anesthesia. A combination of pectoral nerve block (Pecs II), pecto-intercostal fascial block (PIFB) and supraclavicular nerve block ultrasound-guided were successfully performed. Conclusion This is the first case reporting a novel approach in a patient with severe cardiopulmonary disease who underwent breast surgery in a COVID-19 era.

Nuevas Técnicas en Anestesia Reconstructiva y Estética: Articulo de Revisión

“…La puntuación máxima de dolor registrada fue de 2 en la escala analógica visual 48 horas después de la cirugía. El paciente fue dado de alta a las 72 horas de la cirugía (12).…”

New peripheral nerve blocks and local anesthetics

“…A multicenter, randomized, controlled study reported that the pectoral nerve block-II block was not superior to the infiltration of local anesthetics by the surgeon [8] (Table 1). Even though fascial blocks have been generally used for analgesic purposes rather than primary anesthesia in breast surgery, the combination of Pectoral nerve block-II, pectointercostal fascial block, and supraclavicular nerve branch blocks was stated to be successful in providing anesthesia in simple mastectomy and in reducing the ICU stay duration of a high-risk patient in the coronavirus disease 2019 (COVID-19) period [9].…”

Comparison between thoracic paravertebral block and segmental thoracic spinal anesthesia in breast cancer surgery

“…General anesthesia (GA) is commonly used for breast cancer surgery. However, in the time of COVID-19 (Días et al 2021 ), and in some critical patients, regional anesthesia may be used as a sole technique including high thoracic epidural anesthesia (Yektas et al 2014 ; Rangrez et al 2020 ); combined facial plane blocks (Días et al 2021 ; Gutiérrez et al 2019 ; Munasinghe et al 2021 ); paravertebral block (Buckenmaier et al 2002 ; Oğuz et al 2007 ; Nikam et al 2014 ; Pangthipampai et al 2020 ); segmental thoracic spinal anesthesia (Elakany and Abdelhamid 2013 ; Madishetti et al 2017 ; Caruselli and Michel 2020 ); and tumescent anesthesia (Khater et al 2017 ).…”