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PECS II AND PARASTERNAL BLOCK FOR BILATERAL QUADRANTECTOMY AND AXILLARY SURGERY IN A HIGH ANESTHETIC-RISK PATIENT
Author(s): ,
Fusco, P.*
Affiliations:
University of l'Aquila, Department of Anesthesia and Intensive Care Unit- San Salvatore Academic Hospital of L’Aquila- L’Aquila- Italy, L'Aquila, Italy
,
de sanctis, F.
Affiliations:
University of l'Aquila, Department of Life- Health and Environmental Sciences- University of L’Aquila- L’Aquila- Italy, L'Aquila, Italy
,
ruotolo, F.
Affiliations:
university of campania "Luigi Vanvitelli", anesthesia- intensive care and pain management unit, naples, Italy
,
scimia, P.
Affiliations:
A.S.S.T. of Cremona, Department of Anesthesia and Perioperative Medicine- A.S.S.T. of Cremona- Cremona- Italy, cremona, Italy
,
Di Carlo, S.
Affiliations:
university of Chieti- L'Aquila, Department of Anesthesia- Resuscitation- Intensive and Pain Care- University of Chieti- L’Aquila- Italy, chieti, Italy
,
Degan, G.
Affiliations:
university of Chieti- L'Aquila, Department of Anesthesia- Resuscitation- Intensive and Pain Care- University of Chieti- L’Aquila- Italy, chieti- l'aquila, Italy
Marinangeli, F.
Affiliations:
University of l'Aquila, Department of Life- Health and Environmental Sciences- University of L’Aquila- L’Aquila- Italy, L'Aquila, Italy
ESRA Academy. fusco p. Sep 13, 2017; 190870
Topic: REGIONAL ANAESTHESIA TECHNIQUES - BLOCK PERFORMANCE
Dr. pierfrancesco fusco
Dr. pierfrancesco fusco

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Abstract
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Background and Aims:

The new blocks of chest wall such as PECS block, Serratus Plane block and Parasternal block, provide a valid analgesia in  breast surgery’s operations. The same blocks could be an alternative to general anesthesia using anesthetic concentrations of LA, especially in patients with high perioperative risk.

Methods:

We present the case of a 69-year-old patient affected by ischaemic heart disease, hypertension, severe COPD, chronic HBV-related epatopathy, classified ASA 4, undergoing bilateral quadrantectomy and right axillary dissection. On the left breast we performed PECS 2 Block under ultrasound guidance by injecting 0.5% Levobupivacaine 20 ml between Pectoralis Minor and Serratus Anterior muscles at the level of 4th rib. On the right breast, we performed both ultrasound-guided PECS 2 block at the same LA of the left side and Parasternal Block by injecting Levobupivacaine 0.375% 5 ml at the level of 2nd rib and 5 ml at the level of 4th rib. Sedation was ensured with propofol 2-3 ng/ml and supplemental oxygen (3 lt/min) was administered. HR, MAP, SpO2, EtCO2 and BIS were monitored.

Results:

An adequate anesthetic plan was obtained without significant haemodinamic alterations. The technique also provided a good-quality analgesia in the postoperative period without needing NSAIDs nor opiates.

Conclusions:

The new blocks of the chest wall could be a suitable opioid sparing anesthetic technique alternative to general anesthesia particularly in patients at high anesthetic risk. The parasternal block provided an adequate anesthesia of the medial quadrant of the breast. Further studies are needed to confirm our results.

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