CASE REPORT - A COMBINATION OF THORACIC SPINAL ANESTHESIA AND ERECTOR SPINAE PLANE BLOCK FOR MODIFIED RADICAL MASTECTOMY

Thoracic spinal anesthesia is attaining popularity in recent times as it avoids the risks and complications associated with general anesthesia. It provides good motor and sensory block, has decreased incidence of post-operative nausea and vomiting (PONV) and provides good post-operative analgesia. Erector Spinae Plane Block (ESPB) is a new and novel fascial block technique used for post-operative analgesia in breast surgeries by causing sensory blockade of multiple segments of the chest wall. Hereby presenting the case of a 67-year-old female, who came with lump in left breast for 7 months. FNAC revealed that the lump was infiltrating ductal carcinoma. Right sided MRM with axillary lymph node dissection was planned. ESPB was performed at right T4 transverse process by landmark technique with a 23G spinal needle and 12cc of Inj. Levobupivacaine (0.25%) was injected after negative aspiration of CSF & Blood. Following this, subarachnoid block was given at T4-T5 interspace with a 25G Quincke needle and Inj. Levobupivacaine (0.5%) 1.2ml & Inj. Fentanyl 25mcg was injected after free flow of CSF was confirmed. Spinal onset of sensory block was checked after 5,10,15 minutes of block by testing for loss of sensation in the mid-axillary line from C8-T7 using a needle. The patient was hemodynamically stable throughout the procedure. VAS was considerably lower throughout the procedure and the patient did not require any intravenous analgesics. Thoracic spinal anesthesia when combined with Erector spinae block is a safe anesthetic modality that can be employed for Modified Radical Mastectomies. This combination not only provides good sensory block, decreased complications as compared to general anesthesia, better intraoperative hemodynamics, decreased blood loss but also can provide excellent post operative analgesia for a selective subgroup of patients undergoing MRM.