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Paravertebral somatic nerve blocks for breast surgery in a patient with hypertrophic obstructive cardiomyopathy
Chester C Buckenmaier1, Susan M Steele, Karen C Nielsen
1Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA. bucke001@mc.duke.edu
Insights
Paravertebral nerve blocks (PVB) offer effective pain relief for patients with hypertrophic obstructive cardiomyopathy (HOCM) undergoing surgery. This anesthetic technique provides excellent analgesia, proving a valuable alternative for managing HOCM patients during major breast procedures.
Area of Science:
- Anesthesiology
- Cardiology
- Oncology
Background:
- Hypertrophic obstructive cardiomyopathy (HOCM) is a genetic disorder causing myocardial thickening, posing anesthetic challenges.
- Managing HOCM patients requires careful consideration due to potential hemodynamic instability.
Observation:
- A 72-year-old female with HOCM underwent partial mastectomy and axillary lymph node dissection.
- Paravertebral nerve blocks (PVB) were administered at thoracic levels T1-T6 using 0.5% ropivacaine with epinephrine.
Findings:
- The patient required no intraoperative analgesics and remained comfortable during the 2-hour procedure.
- Excellent postoperative analgesia was achieved with PVB, eliminating the need for opioids until the following day.
Implications:
- PVB represent a safe and effective anesthetic alternative for HOCM patients undergoing major breast surgery.
- This approach minimizes systemic drug administration, crucial for patients with cardiovascular compromise.
Purpose:
Patients with hypertrophic obstructive cardiomyopathy (HOCM), a genetic disorder resulting in idiopathic myocardial thickening, can present the anesthesiologist with significant management difficulties. This report reviews the physiology of this important disease process and describes the use of paravertebral nerve blocks (PVB) in the management of a patient with HOCM who presented for partial mastectomy with axillary lymph node dissection.
Clinical Features:
A 72-yr-old female presented for breast cancer surgery with a significant past medical history of HOCM diagnosed during hospitalization for non-small cell lung cancer. PVB were performed at thoracic levels 1-6 and 5 mL of 0.5% ropivacaine and epinephrine 1:400,000 was injected at each level. Intraoperatively the patient required no other medication for analgesia and was comfortable and conversant during the two-hour procedure. She remained pain free following the operation and did not require any opioid medication until the following day.
Conclusions:
PVB provide excellent analgesia and are a useful alternative anesthetic when faced with the HOCM patient requiring major breast surgery.