Ultrasound-guided fascial plane blocks as unique anesthetic technique for total mastectomy in a covid-19 era: A case report

Rev Esp Anestesiol Reanim (Engl Ed). 2021 Aug-Sep;68(7):408-413. doi: 10.1016/j.redare.2020.09.004. Epub 2021 Feb 18.

Abstract
in English, Spanish

Introduction: Regional anesthesia techniques were recently introduced to provide analgesia for breast surgery. These techniques are rarely used as the primary anesthesia due to the complexity of breast innervation, with numerous structures that can potentially be disrupted during breast surgery.

Case report: A female patient in her sixties diagnosed with invasive ductal carcinoma on her left breast was scheduled for a simple mastectomy. After anesthetic evaluation, identification of high risk perioperative cardiovascular complications, it was proposed to perform the surgery only with regional anesthesia. A combination of pectoral nerve block (Pecs II), pecto-intercostal fascial block (PIFB) and supraclavicular nerve block ultrasound-guided were successfully performed.

Conclusion: This is the first case reporting a novel approach in a patient with severe cardiopulmonary disease who underwent breast surgery in a COVID-19 era.

Introducción: Se han introducido recientemente técnicas de anestesia regional, para aportar analgesia en la cirugía de mama. Dichas técnicas son raramente utilizadas como anestesia primaria, debido a la complejidad de la inervación de la mama, con numerosas estructuras que pueden verse potencialmente alteradas durante la cirugía.

Caso clínico: Paciente femenino de unos 70 años con diagnóstico de carcinoma ductal invasivo en la mama izquierda, programada para mastectomía simple. Tras la evaluación anestésica e identificación de complicaciones cardiovasculares perioperatorias de alto riesgo, fue propuesta para cirugía con anestesia regional únicamente. Se realizó una combinación exitosa de bloqueo del nervio pectoral (Pecs II), bloqueo fascial pecto-intercostal (PIFB) y bloqueo ecoguiado del nervio supraclavicular.

Conclusión: Este es el primer caso que reporta una técnica novedosa en una paciente con enfermedad cardiopulmonar severa, a quien se practicó cirugía de mama en la era de la COVID-19.

Keywords: Bloqueo Pecs II; Bloqueo del nervio supraclavicular; Bloqueo fascial pecto-intercostal; Breast surgery; COVID-19; Cirugía de mama; Pecs II block; Pecto-intercostal fascial block; Supraclavicular nerve block.

Publication types

  • Case Reports

MeSH terms

  • Anesthetics*
  • Breast Neoplasms* / surgery
  • COVID-19*
  • Female
  • Humans
  • Mastectomy
  • Mastectomy, Simple
  • Middle Aged
  • Nerve Block*
  • SARS-CoV-2
  • Stroke Volume
  • Ultrasonography, Interventional*
  • Ventricular Function, Left

Substances

  • Anesthetics