Which anesthetic technique you consider more suitable for unilateral breast surgery?
A) Epidural block + GA
B) Paravertebral block + sedation
C) PECs block + GA
D) Paravertebral block + GA
In fact all techniques are valid.
Thoracic epidural and paravertebral blocks became the gold standard for those surgeries. However, the paravertebral block compared with epidural has lower rate of complications (abscess / hematoma, dural puncture), especially if you perform it using ultrasound guidance.
The paravertebral block (even in continuous technique) cannot be trusted when associated only with sedation. You may be required a multi level puncture to obtain a satisfactory anesthesia, which increases the risk of complications. The ideal will be associate the paravertebral block and general anesthesia (GA).
The ultrasound-guided PECs (with GA), seems to be a promising alternative to the paravertebral block, with less risk than it. This is a superficial block that also allows an effective analgesia in extensive breast surgery with axillary involvement.
Therefore, we consider that the most beneficial techniques for patient undergoing breast surgery are the C and D options, since you're comfortable when performing the technique.