21 Continuous thoracic paravertebral block for simple mastectomy in a patient with multiple comorbidities – a case report

Background and Aims Anesthetic management in patients with multiple comorbidities is challenging for anesthesiologists. Aim: To highlight the role of continuous thoracic paravertebral block (TPVB) for providing effective anesthesia and analgesia in breast surgery. Methods A 63 years old female with uncontrolled hypertension, hypothyroid and coronary artery disease ( LVEF 26%, NYHA Class III ) was scheduled for urgent simple mastectomy for Phylloides tumour of the right breast. Ultrasound guided continuous thoracic paravertebral block was performed at T4 level administering 20 ml of 0.75% ropivacaine bolus followed by 0.2% ropivacaine infusion. Intraoperative sedation was maintained with dexmedetomidine infusion. 0.2% ropivacaine infusion at 5 ml/hr was continued for 48 hrs, after that catheter was removed. Results Continuous TPVB provided adequate anesthesia, good hemodynamic stability and opioid sparing perioperative analgesia. The VAS score in postoperative period at rest was 2/10 and on movement was 3/10. There were no block related complications. Conclusions Continuous thoracic paravertebral block is quite effective for breast surgery with comparative efficacy but lesser complications than general anesthesia.