COMBINED ERECTOR SPINAE PLANE AND PECTORAL NERVE II BLOCK FOR BREAST CANCER SURGERY IN A PATIENT WITH SEVERE VALVULAR HEART DISEASE: A PATIENT CENTERED APPROACH
Keywords:
Regional anaesthesia, Pectoral Nerve Block, Erector Spinae Plane Block, Valvular heart disease, Breast cancer surgeryAbstract
Regional anaesthesia techniques are useful for breast cancer surgery, and in certain situations when general anaesthesia deemed high risk, they can be employed as a sole anaesthetic technique. We present a case report of an 85-year-old patient presented with severe valvular heart diseases who underwent Left Breast Wide Local Excision and Axillary lymph nodes dissection. Using Erector Spinae Plane Block (ESPB) and Pectoral Nerve Block II (PEC 2) as the only anaesthetic approach, the surgical procedure was successfully conducted. Our aim was to provide effective surgical anaesthesia while minimizing the potential risks associated with general anaesthesia in this high-risk cardiovascular patient population.
References
1. Khan NH, Duan SF, Wu DD, Ji XY. Better Reporting and Awareness Campaigns Needed for Breast Cancer in Pakistani Women. Cancer Manag Res 2021;13:2125–9.
2. Zeng X, Jiang S, Ruan S, Zhu L, Lian H, Liu M, et al. Cardiovascular risk factors and breast cancer incidence in a large middle-aged cohort study. BMC Cancer 2022;22(1):534.
3. Garg R, Bhan S, Vig S. Newer regional analgesia interventions (fascial plane blocks) for breast surgeries: Review of literature. Indian J Anaesth 2018;62(4):254–62.
4. Chin KJ, Versyck B, Pawa A. Ultrasound-guided fascial plane blocks of the chest wall: a state-of-the-art review. Anaesthesia 2021;76(Suppl 1):110–26.
5. Kim DH, Kim S, Kim CS, Lee S, Lee IG, Kim HJ, et al. Efficacy of Pectoral Nerve Block Type II for Breast-Conserving Surgery and Sentinel Lymph Node Biopsy: A Prospective Randomized Controlled Study. Pain Res Manag 2018;15:4315931.
6. Pawa A, King C, Thang C, White L. Erector spinae plane block: the ultimate 'plan A' block? Br J Anaesth 2023;130:497–502.
7. Hong B, Yoon SH, Youn AM, Kim BJ, Song S, Yoon Y. Thoracic interfascial nerve block for breast surgery in a pregnant woman: a case report. Korean J Anesthesiol 2017;70(2):209–12.
8. Campos M, Azevedo J, Mendes L, Rebelo H. Pectoral nerve block as a single anesthetic technique for breast surgery and sentinel lymph node investigation. Rev Esp Anestesiol Reanim (Engl Ed) 2018;65(9):534–6.
9. Selvi O, Tulgar S. Use of the Ultrasound-Guided Erector Spinae Plane Block in Segmental Mastectomy. Turk J Anaesthesiol Reanim 2019;47(2):158–60.
10. Gola W, Białka S, Andrzejewska A, Palaczynski P, Misiołek H. Fascial plane blocks for breast surgery - current state of knowledge. Anaesthesiol Intensive Ther 2022;54(3):262–70.
11. Thota RS, Seshadri R, Panigrahi AR. Combined fascial plane blocks as the sole regional anesthesia technique for breast surgery in high-risk patients. J Anaesthesiol Clin Pharmacol 2023;39(2):312–6.
12. De Cassai A, Marchet A, Ori C. The combination of erector spinae plane block and pectoralis blocks could avoid general anesthesia for radical mastectomy in high risk patients. Minerva Anestesiol 2018;84(12):1420–1.
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