Title: Regional anesthesia technique for modified radical mastectomy-thoracic paravertrebral block

Biography:

Kalpana Kulkarni has completed her post-graduation at the age of 25 from National Board of Examination Delhi. Also received Fellowship in Pain Management. She is the Professor and Head of Department of Anaesthesiology at Dr. D Y Patil Medical College Hospital and Research Institute. She is postgraduate guide of 8 students. Past President of Indian Societ of Anaesthesiologists -Kolhapur City Branch. She has keen interest in pain management and runs a private Pain Clinic. She has 24 publications to her credit.

Abstract

Conventionally general anaesthesia (GA) is considered gold standard for radical mastectomy however currently regional anaesthesia (RA) techniques are gaining popularity over GA because of the distinct advantages of lesser stress responses, eliminates airway related problems/ complications and facilitates postoperative analgesia. GA poses significant risk in high risk group of patients having hypertention, ischaemic heart diseases and chronic obstructive pulmonary diseases and they are known to be more associated with postoperative nausea vomiting (PONV) and pain following mastectomies. This paper is to present our experience with different RA techniques for radical mastectomy as a sole method of providing surgical anaesthesia over limited field of thoracic segments. Our study comprises of 50 cases of cervical epidural (CE), 25 cases of thoracic epidural (TE) and 50 cases of thoracic paravertebral block (TPVB) for radical mastectomies conducted at our Institution over last 5 years. We observed all the three methods i.e. CE, TE and TPVB are reliable alternative options for radical mastectomies to avoid potential risks and complications with GA and can be administered safely in high risk group of patients. The incidence of PONV and pain was significantly less in patients of regional anaesthesia group so also early ambulation was possible in these patients due to lesser upper limb / shoulder pain. Amongst all TPVB was found to be associated with minimal hemodynamic changes and postoperative complications. TPVB can be considered as a safe and reliable method of providing RA for radical mastectomies even in high risk group of patients.