ESRA Academy. Fusco P. Sep 8, 2016; 138411; 0255 Topic: Anticoagulation- Haemorrhagic Complications
Dr. Pierfrancesco Fusco
Dr. Pierfrancesco Fusco

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Background and Aims:

Dual-antiplatelet therapy reduce incidence of recurrent ischemic stroke, but surgical and anesthetic risk is very high. Ultrasound thoracic wall blocks provide both anesthesia and postoperative analgesia for breast surgery and could improve the peri-operative safety when patient presents several risk factors for bleeding or thromboembolism.


Ultrasound-guided unilateral PECS I and PECS II Block were performed in a 68 years old patients for removal of infected breast implant. She was under dual-antiplatelet therapy (clopidogrel and aspirin) for several ischemic stroke within the last five years (CHA2DS2-VASc=5). 10 ml of 0,375% Levobupivacaine were injected between pectoralis major and minor and at the 4th rib level.  20 ml of 0,5% Levobupivacaine  between pectoralis minor and serratus anterior were injected. Furthermore, an ipsilateral parasternal injection of 8 ml of 0,375% Levobupivacaine under ultrasound guide, was performed close to the external intercostal membrane under the major pectoral muscle, in direction of 2nd and 4th rib, to provide the sensitive block of the parasternal anterior branches of intercostal nerves. Sedation was ensured by 3 mg/kg/h of intravenously propofol. Supplemental oxygen (3 Lt/min) was administered by nasal dispenser. HR, MAP, SaO2%, ETCo2 greater or less than 30% of baseline were treated.


No haemodynamic changes were recorded, no signs or symptoms related to brain damage were detected. Patient went back to the ward with a good control of rest and incidence pain.


US thoracic wall blocks are safety procedures that  ensure good anesthesia and analgesia to prevent dangerous heamodynamic complications in high risk patients, for breast surgery.

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