Thoracic epidural anesthesia for A partial mastectomy

Abstract

A 52-year-old woman was scheduled for partial mastectomy on account of intraductal papilloma of the left breast. RBC 4.89 106/ul, Hb 14.4 g/dl, HCT 42.6%, PLT 306 103/ul, WBC 4.2 109/l, and INR 0.93. ECG and chest x-ray findings were mild left ventricular hypertrophy. She was assigned a class to II of the ASA classification. Informed consent was obtained. In theatre, baseline values were as follows: pulse rate 64/minute, blood pressure 140/80 mmHg, and SpO2 96%. In the sitting position, a midline thoracic epidural was performed at the T4/T5 interspinous space. After a test dose of 4 mL of 1% lidocaine without adrenaline, a loading dose of bupivacaine 10 mL of 0.5% was given. Ten minutes later, a sensory block height of C6 to T10 was achieved bilaterally, and the surgery was started. Oxygen was given via a face mask at 4 L/minute throughout the duration of the surgery, which lasted for 50 minutes. The patient hemodynamic was stable during the surgery, including pulse rate 60/minute, blood pressure 110/90. No sedation and any additional medication were used. Normal saline was infused a total of 2 L. The patient was discharged from the hospital on the third postoperative days. This was the first case of mastectomy under thoracic epidural anesthesia in our hospital and we can’t find any other publication in our country. Thoracic epidural anesthesia is the feasible technique of an alternative choice for a patient with high-risk patients.