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Breast surgery using thoracic paravertebral blockade and sedation alone.

James Simpson¹, Arun Ariyarathenam², Julie Dunn²

¹Department of Anaesthesia, South Devon Healthcare NHS Foundation Trust, Torbay Hospital, Lowes Bridge, Torquay TQ2 7AA, UK ; Department of Anaesthesia, Royal Devon & Exeter NHS Foundation Trust, Barrack Road, Exeter EX2 5DW, UK.

Anesthesiology Research and Practice

|September 13, 2014

Summary

Thoracic paravertebral block (TPVB) with sedation offers effective anesthesia for breast surgery, particularly for patients who cannot undergo general anesthesia (GA). This ultrasound-guided technique provides a reliable alternative when GA is contraindicated or undesirable.

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Area of Science:

Anesthesiology
Surgical Oncology
Regional Anesthesia

Background:

Thoracic paravertebral block (TPVB) combined with general anesthesia (GA) is standard for breast surgery analgesia.
GA may be contraindicated or undesirable for certain patient populations.
Alternative anesthetic techniques are needed for breast cancer surgery.

Purpose of the Study:

To evaluate the efficacy and safety of TPVB with conscious sedation as a sole anesthetic for breast cancer surgery.
To assess the feasibility of this technique in patients with comorbidities or contraindications to GA.

Main Methods:

Twenty-eight patients underwent ultrasound-guided TPVB with propofol or remifentanil-based conscious sedation.
TPVB was performed at one to three thoracic levels using local anesthetic.
Surgeon-administered local infiltration analgesia was used as needed for top-up.

Main Results:

The majority of patients were elderly with significant comorbidities.
TPVB at a single thoracic level was sufficient for 54% of patients.
Fourteen percent required local infiltration top-ups, and 21% needed rescue opioid analgesia.

Conclusions:

Ultrasound-guided TPVB with conscious sedation is an effective and reliable anesthetic for breast surgery.
This technique is a valuable option for patients for whom GA is undesirable or poses high risks.