Journal of Anaesthesia & Critical Care Case Reports

Vol 5 | Issue 2 | May-Aug 2019 | page: 6-9  | Gauri Arora

Authors: Gauri Arora [1]

[1] Consultant Anesthesiologist, Nagpur, Maharashtra, India 440012

Address of Correspondence
Dr. Gauri Arora,
Arora Hospital, 1st Floor,Shreewardhan complex, Near Landmark building,Ramdaspeth, Nagpur, Maharashtra- 440012, India.
E-mail: gauriarora1@yahoo.in

Abstract

Objective: The study is aimed to evaluate the feasibility and safety of cervical epidural anesthesia as the sole anesthetic technique for modified radical mastectomy done for carcinoma breast.
Method: Thirty six breast cancer patients of ASA (American Society of Anesthesiologists) grade I and II underwent MRM under CEA from February 2012 to December 2016. Anesthesia was induced with 12 ml of 1% lignocaine with adrenaline, administered through an 18-gauge cervical epidural catheter placed at C(7)-T(1) epidural space. Top-up dose was given after 1 hour 15 minutes to all the patients with 6ml of 0.25% Bupivacaine and 50 microgram of Fentanyl injection. All patients were given intravenous sedation with midazolam. Oxygen supplemented nasally. In one patient as a planned procedure, an additional lumbar epidural block was given to raise skin graft to fill the defect. In another patient where skin grafting was unplanned, Injection Ketamine 100mg was used. The mean operative time was 123.71± 24.96 minutes.Postoperative analgesia was maintained with Diclofenac Sodium Injection 75 mg at the end of surgery followed by Tramadol injection through the epidural catheter for the first 24 hours according to VAS score. The parameters considered were pulse, blood pressure, oxygen saturation, Supplementation or conversion to GA, blood loss, post-op analgesia and nausea vomiting.
Results: One patient was excluded from the study due to blood tap during catheter placement. Three patients had bradycardia and four patients had hypotension which was treated accordingly. No patient required blood transfusion. No nausea or vomiting in the intra-operative or post operative period. Supplementation or conversion to general anesthesia was not required in any patient. All patients were started on a liquid diet 4 hours after surgery and were mobilized early. Post-operative analgesic requirement was also found to be less.
Conclusion: In this study cervical epidural anesthesia has been found to be not only feasible but also safe and can be used as sole anesthesia modality in cases of carcinoma breast surgery, but it needs to be studied in larger sample population.
Keywords: Cervical epidural, Anesthesia, Breast surgery, Ketamine, Lignocaine, Adrenaline, Bupivacaine.

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