Combined thoracic paravertebral block and interscalene brachial plexus block for modified radical mastectomy: A case report

Table 1 Patients’ characteristics

Case	Sex	Age	BMI, kg/m2	Comorbidities	Surgical procedure	Oncology state
Patient 1	Female	65	21.1	HT, COPD	M + LND	T1N1M0
Patient 2	Female	72	21.4	HT	M + SNB	T2N1M0
Patient 3	Female	65	24.4	HT, COPD	M + LND	T2N3M0
Patient 4	Female	78	24.2	DM, AS	M	-
Patient 5	Female	73	20.2	HT, DM, CI	M + LND	T2N1M0
Patient 6	Female	73	30.4	HT, DM, MI	M	-
Patient 7	Female	65	24.2	HT, AS, MI	M	-
Patient 8	Female	68	21.9	HT, MI	M + SNB	T1N0M0
Patient 9	Female	65	33.6	HT, DM	M + SNB	T2N0M0
Patient 10	Female	79	24.5	DM, MI, CI	M + SNB	T1N1M0

AS: Arteriosclerosis; CI: Cerebral infarction; COPD: Chronic obstructive pulmonary disease; DM: Diabetes mellitus; HT: Hypertension; MI: Myocardial infarction; M: Mastectomy; SNB: Sentinel lymph node biopsy; LND: Lymph node dissection.

Table 2 Timeline of the case series

Case series	Ten elderly and fragile patients with multiple comorbidities scheduled for modified radical mastectomy
Interventions	Standard monitoring and sedation with midazolam in lateral decubitus position before regional anesthesia. 10 and 15 mL of 0.5% ropivacaine injected at T2-T3 and T5-T6 as thoracic paravertebral block by ultrasound-guided using the out-of-plane technique.5 mL of 0.5% ropivacaine injected as interscalene brachial plexus block using the in-plane technique
Results	Sensory blockade assessed by pin prick testing, covering the region between the clavicle and T7 dermatome, and from the ipsilateral parasternal area to the axilla. Only sedated with propofol and oxygen supplementation via a nasal cannula during surgery. Vasopressors, narcotics or general anesthesia was not applied but considered if required for surgery
Follow-up	Postoperative pain was well controlled as a 2 out of 10 points pain score without celecoxib or morphine. Normal food intake was resumed within 4 h and surgical-side hand were able to use within 24 h. Recovery period was uneventful, without complications or postoperative nausea and vomiting