Thoracic Epidural Anesthesia with Ipsilateral Interscalene Nerve Block for Modified Radical Mastectomy in Patients with Cardiorespiratory Compromise: A Prospective Feasibility Case Series

Abstract

Modified radical mastectomy (MRM) is the most common surgical procedure performed for breast carcinoma. It is usually performed under general anesthesia (GA), which becomes challenging in patients with respiratory compromise and multiple comorbidities. Thoracic epidural anesthesia is adequate for simple mastectomies, and when combined with ipsilateral interscalene nerve block, it provides adequate anesthesia for MRM, which involves axillary lymph node (LN) dissection in an outstretched arm that can be a discomfort to the patient. We describe our experience of giving thoracic epidural anesthesia with ipsilateral interscalene brachial plexus block (IBPB) in ten patients posted for MRM. A thoracic epidural was introduced under local anesthesia at T6-T7 intervertebral space and ultrasonography (USG)-guided ipsilateral IBPB was given. A satisfactory anesthetic effect was proved by the absence of tactile sensation over the operative mammary region and axilla within 30 min. This case series demonstrated that combined thoracic epidural anesthesia with ipsilateral IBPB can be used very efficiently in patients posted for MRMs without the need for GA.

Keywords

• a case series
• ipsilateral interscalene brachial plexus block
• modified radical mastectomy
• thoracic epidural anesthesia