engleski

The application of paravertebral block in high- risk patient with cardiorespiratory, liver and kidney problems: a case report

Background and Purpose: We present a case report of a patient of the American Society of Anesthesiologists’ (ASA) IV scheduled for a modified radical mastectomy (MRM) due to malignant disease. The patient was a high risk patient for general anesthesia and we opted for the application of unilateral paravertebral block on several levels. Case report. A 86-year-old female was scheduled for a surgery due to recurrent malignant process on her right breast. She was an ASA IV patient with chronic obstructive pulmonary disease (COPD GOLD A), respiratory failure, diabetes mellitus, diabetic nephropathy, cirrhosis and chronic laryngitis. Echocardiography showed diastolic dysfunction and pulmonary hypertension of moderate degree. During the preparation for the surgery, an invasive blood pressure measurement was set while the paravertebral space was identified with the neurostimulator using the linear ultrasound probe of 8 Hertz (Hz). The anesthetic [0.5% Levobupivacaine (Chirocaine®, Abbott Laboratories)] was applied in levels of Thoracic (Th) 2, Th3, Th4 and Th5 (5 milliliters(ml.) per level). We used 2% lidocaine [Lidocaine®, FC] for local infiltration at the site of the block. Results: Sensory blockade occurred after 32 minutes (min.) and lasted for about 8 hours (h) with normal perioperative period and hemodynamic parameters without accompanying complications. Discussion and Conclusion: This case report shows that the application of paravertebral block with lower doses of long-acting local anesthetic at several levels leads to a satisfactory anesthetic and analgesic effect while maintaining hemodynamic stability.

paravertebral ; local anesthetics ; ultrasound

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