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Case report
DOI: 10.1016/j.redare.2020.09.004
Available online 18 February 2021
Ultrasound-guided fascial plane blocks as unique anesthetic technique for total mastectomy in a covid-19 era: A case report
Bloqueos del plano fascial ecoguiados, como única técnica anestésica para mastectomía total en la era de la COVID-19: caso clínico
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R. Diasa,
Corresponding author
u13003@chporto.min-saude.pt

Corresponding author.
, Â.B. Mendesa, N. Lagesa, H. Machadoa,b
a Serviço de Anestesiologia, Centro Hospitalar e Universitário do Porto, Porto, Portugal
b Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
Received 20 May 2020. Accepted 09 September 2020
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Abstract
Introduction

Regional anesthesia techniques were recently introduced to provide analgesia for breast surgery. These techniques are rarely used as the primary anesthesia due to the complexity of breast innervation, with numerous structures that can potentially be disrupted during breast surgery.

Case report

A female patient in her sixties diagnosed with invasive ductal carcinoma on her left breast was scheduled for a simple mastectomy. After anesthetic evaluation, identification of high risk perioperative cardiovascular complications, it was proposed to perform the surgery only with regional anesthesia. A combination of pectoral nerve block (Pecs II), pecto-intercostal fascial block (PIFB) and supraclavicular nerve block ultrasound-guided were successfully performed.

Conclusion

This is the first case reporting a novel approach in a patient with severe cardiopulmonary disease who underwent breast surgery in a COVID-19 era.

Keywords:
Breast surgery
Pecs II block
Pecto-intercostal fascial block
Supraclavicular nerve block
COVID-19
Resumen
Introducción

Se han introducido recientemente técnicas de anestesia regional, para aportar analgesia en la cirugía de mama. Dichas técnicas son raramente utilizadas como anestesia primaria, debido a la complejidad de la inervación de la mama, con numerosas estructuras que pueden verse potencialmente alteradas durante la cirugía.

Caso clínico

Paciente femenino de unos 70 años con diagnóstico de carcinoma ductal invasivo en la mama izquierda, programada para mastectomía simple. Tras la evaluación anestésica e identificación de complicaciones cardiovasculares perioperatorias de alto riesgo, fue propuesta para cirugía con anestesia regional únicamente. Se realizó una combinación exitosa de bloqueo del nervio pectoral (Pecs II), bloqueo fascial pecto-intercostal (PIFB) y bloqueo ecoguiado del nervio supraclavicular.

Conclusión

Este es el primer caso que reporta una técnica novedosa en una paciente con enfermedad cardiopulmonar severa, a quien se practicó cirugía de mama en la era de la COVID-19.

Palabras clave:
Cirugía de mama
Bloqueo Pecs II
Bloqueo fascial pecto-intercostal
Bloqueo del nervio supraclavicular
COVID-19

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