Carmine Cavallo Antonio Romanelli Renato Gammaldi

Keywords: Breast surgery, superficial parasternal block, deep serratus anterior plane block

Abstract

General anesthesia is the most common anesthesia technique for breast surgery, and opioid administration represents the cornerstone for proper intra- and post-operative pain management. However, opioid use is associated with many side effects (delayed awakening, hyperalgesia, nausea, vomiting, itching, and respiratory depression), affecting the patient’s clinical outcome and satisfaction. Furthermore, evidence suggests that opioids promote disease progression, affecting both cellular and humoral immune function in humans. Indeed, general anesthesia increases the risk of postoperative pulmonary complications, especially in elderly patients with comorbidities. In this setting, regional anesthesia represents an intriguing and innovative approach to managing perioperative pain, decreasing opioid consumption and related adverse effects, and reducing the risk of postoperative pulmonary complications.

Here, we describe the safety and effectiveness of the deep serratus anterior plane block and superficial parasternal block, combined with deep sedation with propofol and dexmedetomidine, as a primary anesthetic technique in a patient with an assessed high risk for the development of postoperative pulmonary complications and scheduled for mastectomy with sentinel lymph node biopsy, followed by axillary lymph node dissection.

Abbreviations: dSAPB - deep serratus anterior plane block; NRS - Numerical Rating Scale; PPCs - postoperative pulmonary complications; sPSB - superficial parasternal block; SA - serratus anterior

Keywords: Breast surgery, superficial parasternal block, deep serratus anterior plane block

Citation: Cavallo C, Romanelli A, Gammaldi R. Deep serratus anterior plane block and superficial parasternal block for awake mastectomy in a high-risk patient. Anaesth. pain intensive care 2024;28(3):577−581; DOI: 10.35975/apic.v28i3.2480

Received: January 16, 2024; Reviewed: May 21, 2024; Accepted: May 21, 2024