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ULTRASOUND-GUIDED PECS I-II AND PARASTERNAL BLOCK FOR AWAKE BREAST SURGERY IN A HIGH ANESTHETIC-RISK PATIENT. A CASE REPORT
Author(s): ,
Fusco , P.*
Affiliations:
San Salvatore Hospital, Department of Anesthesia and Intensive Care Unit, L'Aquila, Italy
,
Degan, G.
Affiliations:
University of L'Aquila, Department of Life Health&Environmental Sciences, L'Aquila, Italy
,
Testa , A.
Affiliations:
University of L'Aquila, Department of Life Health&Environmental Sciences, L'Aquila, Italy
,
Luciani, A.
Affiliations:
University of L'Aquila, Department of Life Health&Environmental Sciences, L'Aquila, Italy
,
Petrucci, E.
Affiliations:
San Salvatore Hospital, Department of Anesthesia and Intensive Care Unit, L'Aquila, Italy
,
De Paolis, V.
Affiliations:
University of L'Aquila, Department of Life Health&Environmental Sciences, L'Aquila, Italy
Marinangeli, F.
Affiliations:
University of L'Aquila, Department of Life Health&Environmental Sciences, L'Aquila, Italy
ESRA Academy. fusco p. Sep 13, 2017; 190691
Topic: Peripheral Nerve Blocks
Dr. pierfrancesco fusco
Dr. pierfrancesco fusco

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Abstract
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Background and Aims:

PECS I-II association in addition to parasternal block could represent a valuable alternative to general anesthesia and locoregional conventional techniques in breast surgery, especially in high-risk patients.

Methods:

A 68-year-old man, ASA-3, underwent undelayable radical mastectomy with axillary dissection for an invasive breast cancer. In history, obesity, COPD and OSAS in CPAP treatment, paroxystic atrial fibrillation, oral anticoagulant therapy, recent myocardial infarction. Written informed consent to the treatment was obtained. In the operating room, prior routine monitoring and administration of oxygen 2 lt/min with nasal cannula and Sufentanyl 5 mcg iv, ultrasound-guided PECS I and PECS II block through a single puncture site and parasternal block were performed. Using a high-frequency linear probe and a 20G SonoPlex Stim cannula, PAJUNK® needle, we injected 10 ml of Levobupivacaine 0.375% between pectoralis major and pectoralis minor, 20 ml between pectoralis minor and serratus anterior and 5 ml +5 ml between pectoralis major and intercostal muscles at the level of the 2nd and 4th rib. The patient was sedated with propofol (2-3 ng/ml) maintaining spontaneous breathing. EtCO2 was monitored.

Results:

The intervention started 30 minutes later and lasted 65 minutes. The patient reported no pain during the procedure, maintaining spontaneous breathing and an adequate hemodynamic stability.  He was admitted to the surgical ward without pain nor complications.

Conclusions:

PECS I and II in association with parasternal block, have provided an adequate intraoperative hemodynamic stability and an excellent postoperative analgesia, avoiding the administration of additional systemic analgesics.

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