Document resource
Background and Aims Oncological breast surgery is usually performed under general anaesthesia and surgical interventions with locoregional blocks as the sole anaesthetic agent are rarely performed. We present a retrospective observational case series of 15 patients who underwent breast surgery under locoregional anaesthesia with perioperative sedation. Locoregional anaesthesia consisted of thoracic paravertebral or erector spinae blocks, combined with a PECS-2 nerve block.Methods All blocks were performed pre-operatively. An ultrasound-guided multi-injection thoracic paravertebral block (TPVB) or Erector Spinae block (ESB), followed by a PECS-2 block (recently redefined as the interpectoral-pectoserratus plane block) was performed. The maximal injectable volume of ropivacaine was calculated before placing the block, taking into account a maximal dose of 2.5 mg/kg. All blocks were performed by the same anaesthesiologist with substantial experience in ultrasound guided locoregional anaesthesia.Patients were monitored before and throughout surgery for signs of pain and distress. If necessary, a conversion to general anaesthesia was performed. Patients were transferred to the recovery ward after the procedure. Pain scores were monitored with the 11-point numeric rating scale ( 0 = no pain, 10 = worst pain imaginable) and additional pain administration (piritramide IV) was registered. Data were analysed with R (4.4.0) and are reported as mean with standard deviation, number or percentage, depending on the underlying distribution.Results Fifteen patients were included in this case series. Twelve subjects had a TPVB plus PECS-2 block, two had a erector spinae block plus PECS-2 block, one had a PECS-2 block solely.3 The technique was successful in 13 patients, two patients needed conversion to GA, both before the start of the surgery.Conclusions We conclude this is a feasible alternative anaesthetic approach for breast surgery in selected cases.