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

 

 

 

Solution:

 

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.

 

 

QUESTIONS & ANSWERS...  SOLUTION 10

Source: Ovid: Clinically Oriented Anatomy