Early experience with high thoracic epidural anesthesia in outpatient submuscular breast augmentation

High thoracic epidural anesthesia was administered by anesthetists in 20 patients undergoing submuscular breast augmentation. An average of 12 ml of 2% lidocaine was instilled after sedation with midazolam, 2-6 mg. The augmentation procedure averaged 90 minutes. In 3 patients, the block developed more rapidly on one side than the other, but soon became symmetrical in all; additional subcutaneous infiltration of lidocaine was necessary in 1 patient because of infraclavicular pain; ephedrine, 10 mg was needed in 2 patients to treat hypotension (greater than 20% decrease in blood pressure). Three patients felt infraclavicular pressure; 1 had a brief sensation of breathlessness; 3 had nasal stuffiness from Horner's syndrome associated with the block; none developed headache, back pain, or paresthesias; and 3 had postoperative nausea. The average time from the end of the procedure to patient discharge was 96 minutes. In this limited series, high thoracic epidural anesthesia for submuscular breast augmentation was extremely satisfactory.