Management of Radical Mastectomy under Sole Thoracic Paravertebral Block in a 92 years Old Patient with Cardio- Pulmonary Dysfunction

Radical mastectomy is routinely performed under general anaesthesia, but geriatric patients with compromised cardio-pulmonary function are at increased risk of morbidity and mortality. We report successful perioperative management of radical mastectomy with sole paravertebral block in a 92 years old female with compromised cardio-pulmonary function and kyphoscoliotic spine. Single needle thoracic paravertebral block was given at T4 level using tuohy’s needle and 18 guage epidural catheter was inserted 3cm into the paravertebral space on right side. Ropivacaine 0.5%, 15ml (75mg, 1.5/kg) with fentanyl 25mcg (0.5mcg/kg) was injected through the catheter. There was good hemodynamic stability, surgical field and postoperative analgesia. Thus sole paravertebral block as an anaesthetic technique is a good option for unilateral surgical anaesthesia for radical mastectomy with minimal hemodynamic changes especially in high risk patients.