Ultrasound Guided Regional Anaesthesia for Breast Surgery in High Risk Patients- A Retrospective Observational Study

Vol 3 | Issue 2 | July-December 2022 | Page 93-97 | Harshal D Wagh, Shruthi Pendalya, Mandar Nadkarni

DOI: 10.13107/ijra.2022.v03i02.061


Authors: Harshal D Wagh [1], Shruthi Pendalya [1], Mandar Nadkarni [2]

[1] Department of Anaesthesia, Kokilaben Ambani Hospital, Mumbai, Maharashtra, India.
[2] Department of Oncosurgery, Kokilaben Ambani Hospital, Mumbai, Maharashtra, India.

Address of Correspondence
Dr. Harshal D Wagh,
Department of Anaesthesia, Kokilaben Ambani Hospital, Mumbai, Maharashtra, India.
E-mail: drhdw2701@gmail.com


Abstract

Introduction: Modified radical mastectomy (MRM) or breast conservative surgery (BCS) done under general anaesthesia (GA) in high-risk patients may be associated with significant morbidity, Intensive Care Unit stay and increased hospital stay leading to cost issues. In this case-series, we describe our experience with regional anesthesia for MRM or BCS and sentinel / complete axillary clearance in 61 patients with breast carcinoma who were high risk for perioperative complications in view of their co-morbidities. None required ICU or increased hospital stay postoperatively.
Material & Methods: Sixty-one ASA III/IV patients operated under regional anaesthesia for carcinoma of the breast were included. Multiple level USG guided thoracic paravertebral block (PVB), PECS block (1/2), Pecto-intercostal fascial block (PIFB), Serratus-anterior plane block (SAPB), brachial plexus block, Superficial cervical plexus blocks (SCPB), Erector spinae block (ESB) were given in different combinations.
Result: There were 60 female patients (Age: 30-97 years) and 1 male patient (59 years) (Left side -27 patients, right side- 34 patients). Of the total 61 patients, 23 patients underwent BCS with axillary dissection, 36 patients underwent MRM with axillary dissection, 2 patients had MRM with Pectoralis Major muscle resection. Patients received different combinations of blocks PVB or ESB, PECS1/2 and SAPB. 43 patients received the PVB, 61 got the PECS1/2, 12 patients received ESP, 32 patients required SCPB, 1 infra-clavicular block and 35 patients got PIFB. All procedures were completed under regional anaesthesia with 51 patients getting intravenous midazolam (0.01-0.02mg/kg), 59 patients were given IV fentanyl (1-3ug/kg , 43 patients were given IV propofol (1-2mg/kg), These were given in small aliquots during the duration of the procedure. 2 patients had IV ketamine (0.5mg/kg) and 1 patient had IV dexmeditomidine (0.2-0.3ug/kg/hr). IV paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDS) ie. Inj Diclofenac Sodium IV in the dose of 1mg/kg (max 75mg) were given when not contraindicated.
There was single case of axillary hematoma with no other complications. No patient required ICU care postoperatively and were discharged as routine.
Conclusion: A combination of blocks may be an option for surgical anaesthesia for breast surgeries in high risk patients. Careful planning, patient counseling and attention to toxic dose of local anaesthetics must always be considered.
Keywords: Paravertebral block, Thoracic wall blocks, PECS block, Serratus Anterior plane block, Pecto-intercorstal fascial block, Superficial cervical plexus, Modified radical mastectomy, Breast conservative surgery.


References


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How to Cite this Article: Wagh HD, Pendalya S, Nadkarni M | Ultrasound Guided Regional Anaesthesia for Breast Surgery in High Risk Patients- A Retrospective Observational Study | International Journal of Regional Anaesthesia | July-December 2022; 3(2): 93-97.


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    Tải Hit Club iOSHIT CLUBHit Club đã sáng tạo ra một giao diện game đẹp mắt và hoàn thiện, lấy cảm hứng từ các cổng casino trực tuyến chất lượng từ cổ điển đến hiện đại. Game mang lại sự cân bằng và sự kết hợp hài hòa giữa phong cách sống động của sòng bạc Las Vegas và phong cách chân thực. Tất cả các trò chơi đều được bố trí tinh tế và hấp dẫn với cách bố trí game khoa học và logic giúp cho người chơi có được trải nghiệm chơi game tốt nhất.

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    Bạn có thể trải nghiệm Hit Club với 2 phiên bản: Hit Club APK cho thiết bị Android và Hit Club iOS cho thiết bị như iPhone, iPad.

    Tải ứng dụng game:

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    Chờ cho quá trình tải xuống hoàn tất.
    Cài đặt ứng dụng:

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    Bắt đầu trải nghiệm:

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    Tải Hit Club iOS
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    Trên trang chủ của Hit Club, người chơi dễ dàng tìm thấy các game bài, tính năng hỗ trợ và các thao tác để rút/nạp tiền cùng với cổng trò chuyện trực tiếp để được tư vấn. Giao diện game mang lại cho người chơi cảm giác chân thật và thoải mái nhất, giúp người chơi không bị mỏi mắt khi chơi trong thời gian dài.

    Hướng Dẫn Tải Game Hit Club
    Bạn có thể trải nghiệm Hit Club với 2 phiên bản: Hit Club APK cho thiết bị Android và Hit Club iOS cho thiết bị như iPhone, iPad.

    Tải ứng dụng game:

    Click nút tải ứng dụng game ở trên (phiên bản APK/Android hoặc iOS tùy theo thiết bị của bạn).
    Chờ cho quá trình tải xuống hoàn tất.
    Cài đặt ứng dụng:

    Khi quá trình tải xuống hoàn tất, mở tệp APK hoặc iOS và cài đặt ứng dụng trên thiết bị của bạn.
    Bắt đầu trải nghiệm:

    Mở ứng dụng và bắt đầu trải nghiệm Hit Club.
    Với Hit Club, bạn sẽ khám phá thế giới game đỉnh cao với giao diện đẹp mắt và trải nghiệm chơi game tuyệt vời. Hãy tải ngay để tham gia vào cuộc phiêu lưu casino độc đáo và đầy hứng khởi!

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    В мире современных вычислений виртуальные сервера (VPS/VDS) и дедик сервера становятся ключевыми элементами успешного бизнеса и онлайн-проектов. Выбор оптимальной операционной системы и типа сервера являются решающими шагами в создании надежной и эффективной инфраструктуры. Наши VPS/VDS серверы Windows и Linux, доступные от 13 рублей, а также дедик серверы, предлагают целый ряд преимуществ, делая их неотъемлемыми инструментами для развития вашего проекта.

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  179. Angelowrowl
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  184. Charlestup
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    В мире современных вычислений виртуальные сервера (VPS/VDS) и дедик сервера становятся ключевыми элементами успешного бизнеса и онлайн-проектов. Выбор оптимальной операционной системы и типа сервера являются решающими шагами в создании надежной и эффективной инфраструктуры. Наши VPS/VDS серверы Windows и Linux, доступные от 13 рублей, а также дедик серверы, предлагают целый ряд преимуществ, делая их неотъемлемыми инструментами для развития вашего проекта.

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  189. Angelowrowl
    Angelowrowl says:

    オンラインカジノ
    オンラインカジノとオンラインギャンブルの現代的展開
    オンラインカジノの世界は、技術の進歩と共に急速に進化しています。これらのプラットフォームは、従来の実際のカジノの体験をデジタル空間に移し、プレイヤーに新しい形式の娯楽を提供しています。オンラインカジノは、スロットマシン、ポーカー、ブラックジャック、ルーレットなど、さまざまなゲームを提供しており、実際のカジノの興奮を維持しながら、アクセスの容易さと利便性を提供します。

    一方で、オンラインギャンブルは、より広範な概念であり、スポーツベッティング、宝くじ、バーチャルスポーツ、そしてオンラインカジノゲームまでを含んでいます。インターネットとモバイルテクノロジーの普及により、オンラインギャンブルは世界中で大きな人気を博しています。オンラインプラットフォームは、伝統的な賭博施設に比べて、より多様なゲーム選択、便利なアクセス、そしてしばしば魅力的なボーナスやプロモーションを提供しています。

    安全性と規制
    オンラインカジノとオンラインギャンブルの世界では、安全性と規制が非常に重要です。多くの国々では、オンラインギャンブルを規制する法律があり、安全なプレイ環境を確保するためのライセンスシステムを設けています。これにより、不正行為や詐欺からプレイヤーを守るとともに、責任ある賭博の促進が図られています。

    技術の進歩
    最新のテクノロジーは、オンラインカジノとオンラインギャンブルの体験を一層豊かにしています。例えば、仮想現実(VR)技術の使用は、プレイヤーに没入型のギャンブル体験を提供し、実際のカジノにいるかのような感覚を生み出しています。また、ブロックチェーン技術の導入は、より透明で安全な取引を可能にし、プレイヤーの信頼を高めています。

    未来への展望
    オンラインカジノとオンラインギャンブルは、今後も技術の進歩とともに進化し続けるでしょう。人工知能(AI)の更なる統合、モバイル技術の発展、さらには新しいゲームの創造により、この分野は引き続き成長し、世界中のプレイヤーに新しい娯楽の形を提供し続けることでしょう。

    この記事では、オンラインカジノとオンラインギャンブルの現状、安全性、技術の影響、そして将来の展望に焦点を当てています。この分野は、技術革新によって絶えず変化し続ける魅力的な領域です。

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  190. Angelowrowl
    Angelowrowl says:

    Как включить аппаратную виртуализацию
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  191. <