Thoracic epidural anesthesia combined with pecs 2 block for modified radical mastectomy: A safe and effective alternative to general anesthesia in high-risk patients

Breast cancer is the most common malignancy among Saudi women, with Modified Radical Mastectomy (MRM) as a standard treatment, typically performed under general anesthesia (GA). However, GA poses significant risks to patients with multiple comorbidities. We present a 66-year-old female with invasive ductal carcinoma, complicated by scleroderma with interstitial lung disease, chemotherapy-induced heart failure, and hypertension, making GA a high-risk option. To optimize perioperative safety, thoracic epidural anesthesia (TEA) combined with a pectoralis nerve block (PECS2) was used instead. This approach provided effective surgical anesthesia, hemodynamic stability, and minimized opioid use. The patient tolerated the procedure well, with intraoperative hypotension managed by vasopressor support. She resumed oral intake within 6 hours, required minimal postoperative opioids, and was discharged on the third postoperative day without complications. This case highlights the feasibility and advantages of TEA with PECS2 block as a safe and effective alternative to GA in high-risk MRM patients. By reducing GA-related pulmonary and cardiac risks, improving postoperative pain control, and shortening hospital stays, this technique may enhance perioperative outcomes in select patients. Further studies are warranted to support the wider adoption of regional anesthesia in oncologic breast surgeries.