[A Case of Bilateral Breast Mastectomy Performed under Local Anesthesia with Ultrasound Guided Nerve Blocks]

The patient was a woman in her 60s with a history of congenital patent ductus arteriosus complicated by severe pulmonary hypertension and Eisenmenger syndrome. She had previously undergone surgery for right-sided breast cancer 11 years earlier. Nine years after surgery, she was diagnosed with bilateral breast cancer. At that time, mediastinal lymph node metastasis was suspected, and the disease was considered unresectable, leading to the initiation of pharmacological therapy. Although treatment was started, tumor progression was observed, prompting a shift toward surgery. Due to the presence of severe pulmonary hypertension, general anesthesia was deemed extremely high risk. Therefore, a surgical plan was made to perform bilateral mastectomy under local anesthesia with the aid of nerve blocks. Pectoral nerve blocks(Pecs blocks)combined with local anesthesia were used, resulting in effective pain control. No intraoperative or postoperative complications occurred. This case suggests that surgery using nerve blocks and local anesthesia may be a valuable option for patients with severe underlying and comorbid conditions in whom general anesthesia poses significant risk.