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P240 Combined deep serratus anterior plane block with pecto-intercostal fascial plane block for awake partial mastectomy: a case series
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P240 Combined deep serratus anterior plane block with pecto-intercostal fascial plane block for awake partial mastectomy: a case series
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P240 Combined deep serratus anterior plane block with pecto-intercostal fascial plane block for awake partial mastectomy: a case series
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Journal Article
P240 Combined deep serratus anterior plane block with pecto-intercostal fascial plane block for awake partial mastectomy: a case series
2025
Overview
Background and AimsRegional anaesthesia for breast surgery has traditionally been used for perioperative pain control and to reduce opioid consumption, but not as primary anaesthesia. To date, there are few published data on awake breast surgery, and these usually involve moderate sedation with propofol.MethodsWe report our case series of 3 patients who successfully underwent a combination of interfascial blocks as the sole anaesthetic technique for outpatient partial mastectomy via a hemi-periareolar incision. The ultrasound-guided blocks were performed with a mixture of lidocaine/epinephrine 9/0.01 mg/ml and consisted of a pecto-intercostal fascial plane block (PIFP) at the level of the fourth costal cartilage and a two-level deep serratus anterior plane block (SAP) over the third and fifth ribs to take advantage of better spread and wider anaesthetic coverage. Doses didn’t exceed the recommended maximum of 7 mg/kg. Prior to surgery, a pinprick test was performed in the mammary area to confirm the efficacy of the block. Anxiolysis was achieved through intermittent intravenous midazolam boluses, with the patients remaining cooperative and relaxed throughout the entire procedure.ResultsTwo of the three patients underwent surgery without incident, but patient 3 experienced mild pain during the incision, which was relieved with a single bolus of 50 micrograms of fentanyl and a local infiltration of 25 milligrams of bupivacaine. The remainder of the procedure was uneventful. Post-operative pain was minimal at all times.Abstract P240 Table 1Outcomes of patients undergoing awake partial mastectomy with interfascial blocksConclusionsAwake breast cancer surgery is feasible and has emerged as a less risky alternative to general anaesthesia with the potential to reduce time to discharge.
Publisher
BMJ Publishing Group LTD
Subject
