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Korean J Anesthesiol > Epub ahead of print
DOI: https://doi.org/10.4097/kja.d.18.00266    [Epub ahead of print]
Published online November 27, 2018.
Erector spinae plane block combined with a novel technique for selective brachial plexus block in breast cancer surgery
Alessandro De Cassai1, Daniele Bonvicini2, Michele Ruol1, Christelle Correale1, Maurizio Furnari1
1Department of Medicine - DIMED, Section of Anaesthesiology and Intensive Care, University of Padua, Padua, Italy
2Department of Urgency and Emergency, Anesthesiology and Intensive Care Unit, University Hospital of Padova, Padova, Italy
Corresponding author:  Alessandro De Cassai, Tel: +39-049-8213090, 
Email: alessandro.decassai@gmail.com
Received: 7 September 2018   • Revised: 30 October 2018   • Accepted: 21 November 2018
Abstract
Breast innervation consists of intercostal nerves and brachial plexus. Here we propose a technique to execute breast surgery without general anesthesia using erector spinae plane (ESP) block and selective block of four nerves arising from brachial plexus and innervating breast and axilla (from now on SBP block.
A 77-year-old male presented for breast cancer with indication to radical mastectomy and axillary clearance. He had a history of myocardial infarction resulting in postinfarction dilated cardiomyopathy with a severe reduction in ejection fraction.
We planned a regional anesthesia technique consisting of an ESP block and a SBP block. No opioids were needed and patient remained comfortable throughout surgery, no additional analgesic administration was required by the patient both during surgery as well as for the following postoperatively days until discharge.
In conclusion, SBP is a novel block thought to provide anesthesia to brachial plexus components involved in innervation of the breast region.
Key Words: Brachial plexus; Erector spinae plane block; Breast surgery; Regional anesthesia
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