PECs blocks as basic anesthesiological technique for breast cancer in a patient with Myestenia gravis

Date Issued
2018-11-23
Author(s)
Dimitrovski Aleksandar
Tolevska Dimitrovska Natasha
Toleska Marija
Abstract
Background : Peck 1 and Peck 2 are superfitial interphascial blocks between the muscles of anterior thoracic wall. They block pectoral and intercostal nerves on the ap- propriate side. Ultrasound guided, the application site is precisely determined, followed by the hydrodysection between the muscles from the local anesthetic. They provide adequate analgesia for breast surgery. Methods : A 72 year old female patient with Myasthenia gravis, ischemic heart disease, arterial hypertension, AFF and varicose veins on the legs, classified as ASA 4 is scheduled for surgery due to breast cancer. Quadrantectomy of the right mammary gland (upper lateral quadrant) with axillary lymph dissection is planned. After setting monitoring, 1 mg of Dormicum, 50 mcg of Fentanyl and amp.Analgin 2.5g was applied. Under ultra-sound on a level of fourth rib first performed Peck 2 block applying 20 mL of 0.5% Bupivacaine between m.pectoralis minor and m.seratus anterior. Then Peck 1 block, applying 10 mL of 0.5% Bupivacaine between minor and major pectoral muscles. The patient is seated with 20 ml / h with Propofol continuously. Results During the intervention, analgesia and comfort of the patient were provided. Vital parameters were stable. In the postoperative period, the patient didn’t re- ceive analgetics. Conclusion: These blocks can be adequate substitute for general anesthesia, es- pecially in patients with comorbidities who need breast surgery. They are simple to perform and with the addition of adequate perioperative analgesia, you can provide significant post-operative analgesia and the use of opiates is reduced to minimum.
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