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ULTRASOUND-GUIDED PECS II BLOCK IN A HIGH-ANESTHETIC RISK PATIENT: CASE REPORT
ESRA Academy. SCIMIA P. Sep 8, 2016; 138293
Topic: Trunk Blocks
PAOLO SCIMIA
PAOLO SCIMIA

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Abstract
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Background and Aims:

The recent introduction of PECS II block in oncological breast surgery, could represent a viable alternative to general anesthesia and locoregional conventional techniques, especially in high anesthetic risk patients.

Methods:

A 78-year-old woman, ASA-3, was scheduled to undergo undelayable quadrantectomy and axillary dissection for an invasive breast cancer. In history, ischemic heart disease, arterial hypertension, moderate mitral insufficiency, rheumatoid arthritis, anxious-depressive syndrome, documented allergy to NSAIDs and opioids. Written informed consent was obtained from the patient. In the operating room, previous routine monitoring and administration of Midazolam 1 mg, ultrasound-guided PECS II was performed by injecting 20 ml of 0,5% Ropivacaine in the fascial plane between pectoralis minor and serratus anterior muscles. An intraoperative sedation with easy arousability was ensured with intravenously propofol infusion (3 mg/kg/h), mantaining spontaneous breathing. Supplemental oxygen (4 lt/min) is administered by Venturi mask and end tidal CO2 was monitored.

Results:

A good quality anesthesia of the mammary and axillary regions was obtained, with an adequate hemodynamic stability and without discomfort for the patient during surgery. Ultrasound-guided PECS II block allowed to obtain a long lasting postoperative analgesia and only 3 g of acetaminophen were administered, avoiding the administration of systemic opioids and NSAIDs, with no occurrence of complications, in a patient with a documented allergy.

Conclusions:

Actually, ultrasound-guided PECS II block could represent a safe and effective alternative to general anesthesia and conventional techniques, especially in this kind of patient with high anesthetic risk.

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