ESRA Academy. Johnson M. Sep 8, 2016; 138525; 0390 Topic: Trunk Blocks
Dr. Mark Johnson
Dr. Mark Johnson

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Background and Aims:

We present a case of a 69 year-old female in whom we performed a Pecs I & II block with intravenous propofol sedation as her sole anaesthetic technique for a total mastectomy and sentinel lymph node biopsy. This patient had significant co-morbidities including extremely low body weight (BMI 14), severe COPD and significant anxiety. She refused neuraxial or paravertebral techniques. She was counseled pre-operatively regarding her high anaesthetic risk and agreed to a Pecs block and sedation. We limited her dose of levobupivicaine to 2mg/kg as we used lignocaine to hasten block onset.


We performed the block using incremental boluses of propofol for sedation. 10ml and 20ml of 0.25% levobupivicaine was used at each level respectively, with an additional 5ml of 1% lignocaine with 1: 200,000 adrenaline to each level. The surgeon supplemented the medial border of the incision with 10 ml of 1% lignocaine/adrenaline.  She otherwise had good local anaesthesia to the breast and axilla. Continuous BIS monitoring was used level of 60-70. FiO2 of 30% was delivered by facemask. No opiate analgesia was administered and the patient woke happily in the Post Anaesthetic Care Unit with complete analgesia and amnesia.


This is the first case report of the use of a Pecs Block as the sole anaesthetic technique for a total mastectomy and lymph node dissection. It highlights the many challenges involved in using a block only technique: patient selection, surgical team cooperation surgeon and achieving safe but effective blockade patients at increased toxicity risk.




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