Paravertebral Block for Anesthetic Management in the Pregnant Population: A Case Series Report
Abstract Number: 182
Abstract Type: Case Report/Case Series
Occasionally, there is a need for women in pregnancy to undergo surgical procedures. Postponing the procedure until after delivery may expose the mother to additional hardship or suffering, even allowing any illness to intensify or progress. When a surgical procedure is indicated, without delay, the penultimate goal is the care of the mother. Secondary, but no less concerning, is the protection of the viability of the pregnancy. This is a case series report of a females undergoing breast cancer surgery resection, utilizing Paravertebral Block.
Anesthesia options were discussed with the multidisciplinary teams, and an initial intervention of Paravertebral Block (PVB) was deemed to be less stressful for the fetus than general anesthesia. All patients were evaluated by the Maternal-Fetal Medicine team, and with the pregnancies dated at, or before, 22-23 weeks, it was deemed no intra-operative monitoring was indicated, as the fetus would not be viable outside the womb. All patients and their families completely understood the implications of this, and agreed to proceed.
A 35 year old female at 23 weeks gestation was diagnosed with a 12x12x4cm angiosarcoma of the left breast. After multidisciplinary conference, there was a consensus for surgical intervention. She was admitted for left total mastectomy.
IV access was obtained, full ASA monitors were placed, and oxygen was administered via face mask with ETCO2 monitoring. Fetal heart tones were obtained. Sedation was provided with 20mg of Famotidine, and divided doses of Fentanyl, totaling 150 micrograms over a 25 minute interval. In the sitting position, a left paravertebral block was performed at thoracic levels T 1-6. The technique used is described in full by Greengrass and Steele (1). A total of 17mL of 1% Ropivicaine w/ 1:400K epi and 19mL of 0.5% Ropivicaine w/ 1:400K epi were used.
After an uneventful block, the patient was placed supine, and a few minutes later the dermatomal loss of sensation was confirmed with ice. The patient was positioned for surgery with a right hip elevation by two sheets for uterine displacement. Surgery was performed with minimal adjuvant supplementation of sedation with Fentanyl. During the 1 hour, 38 minute surgical case, the patient remained comfortable and communicative. After the conclusion of the left total mastectomy, the patient was brought to the PACU. She did have 5/10 nausea, which was treated with 4mgs of Ondansetron. Again, a member of faculty was called to document fetal heart tones.
A 36yo female at 20 weeks gestation was diagnosed with Invasive Ductal Carcinoma of the left breast. There were two lesions in the breast: one at the 3 o'clock position measuring 2 x 2.5 cm, and another at the 5-6 o'clock position, firm and measuring 2.2 x 2.5 cm. The patient was scheduled for a left total mastectomy with intraoperative sentinel node mapping and biopsy, possible axillary node dissection.
IV access was obtained, full ASA monitors were