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A combination of paravertebral and praverticular block and hemodynamics in patient with tuberculosis for a hand skin cancer surgery: a case report

Background and aims Most skin cancer of the hand surgeries with ipsilateral axillar lymphadenectomy are performed under general anesthesia ; therefore, patients with present significant cardiorespiratory problems are at high risk for the development of hemodynamic disorders. Here we show the American Society of Anesthesiologist (ASA) III patient scheduled for melanoma skin cancer surgery. Due to a high risk for general anesthesia, we decided to apply a paravertebral and supraclavicular block. Methods A 50-year-old female, ASA III, was scheduled for melanoma skin cancer surgery with ipsilateral axillar lymphadenectomy of her left hand. The patient had tuberculosis with active treatment, arterial hypertension and obstructive lung disease. During the preparation for the surgery, an invasive blood pressure measurement was set while the paravertebral and supraclavicular space was identified using the linear ultrasound probe of 8 and 12 Hertz. The anesthetic 0.5% levobupivacaine was applied at the levels of Thoracic (Th) 2, Th3 and Th4 (4 milliliters per level) and supraclavicular (15 milliliters). Lidocaine 1% was used for local infiltration at the site of the block. Results Sensory blockade occurred after 20 minutes and lasted for about 10 hours in the axillary region and 18 hours in the operated forearm with stabile hemodynamic parameters with no perioperative complications. Conclusion The application of the ultrasound in the paravertebral and supraclavicular block enabled us to achieve high precision. Such administration of small doses of long-acting local anesthetic at multiple levels has resulted in satisfactory anesthesia and analgesia without hemodynamic and respiratory complications.

melanoma, surgery, hemodynamics, paravertebral block, supraclavicular block

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