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Multiple Thoracic Wall Blocks for Awake Breast Surgery: A Case Report.

Yavuz Gürkan1, İlayda Kalyoncu1, Doğa Şimşek1

  • 1Koç University Faculty of Medicine, Koç University Hospital, Department of Anaesthesiology and Reanimation, İstanbul, Turkey.

Turkish Journal of Anaesthesiology and Reanimation
|December 27, 2023
PubMed
Summary

Awake breast surgeries require multiple thoracic wall nerve blocks for adequate anesthesia. A combination of thoracic paravertebral block, pectoralis nerve block, and serratus anterior plane block proved effective for complex cases.

Keywords:
Awake surgeryPECS blockbreast surgeryserratus anterior plane blockthoracic paravertebral block

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Area of Science:

  • Anesthesiology
  • Regional Anesthesia
  • Surgical Procedures

Background:

  • Awake breast surgery presents anesthetic challenges for anesthesiologists.
  • Thoracic paravertebral block (TPVB) was previously considered sufficient for breast surgery anesthesia.
  • Elderly patients with comorbidities require careful anesthetic management.

Purpose of the Study:

  • To evaluate the efficacy of a combined nerve block approach for awake breast surgery.
  • To address anesthetic challenges in elderly patients with comorbidities undergoing breast surgery.
  • To determine if a single nerve block technique is adequate for breast surgery.

Main Methods:

  • A combination of thoracic paravertebral block (TPVB), pectoralis nerve block, and serratus anterior plane block was utilized.
  • The procedure was performed under sedation for awake breast surgery.
  • The anesthetic technique was applied in an elderly patient with significant comorbidities.

Main Results:

  • Successful surgical anesthesia was achieved, with the exception of skin incision.
  • The combined block approach provided adequate anesthesia for the breast surgery.
  • The patient tolerated the procedure under sedation with regional anesthesia.

Conclusions:

  • A single regional anesthesia technique is insufficient for comprehensive breast surgery anesthesia.
  • Multiple thoracic wall nerve blocks are necessary for effective surgical anesthesia in breast procedures.
  • Combined thoracic wall blocks offer a viable anesthetic option for awake breast surgery, especially in high-risk patients.