Regional for axillary dissection?

Started by Pinkegg
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Pinkegg

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Long time lurker here. So I have a patient who long story short doesn't want general for a node dissection. Anyone successfully perform regional for one of these? It's a tricky spot to cover depending on where the incision extends. I'm thinking interscalene vs thoracic epidural, possibly both, supplemented by the surgeon? Thoughts?
 
If I understand you correctly and you mean axillary node dissection, interscalene will not be sufficient, because you need the T1 coverage.

For mastectomies with axillary node dissection, I do paravertebral blocks at levels T1, T3, and T5 with 0.5% bupi (max total 2mg/kg) + 5mg dexamethasone PF (some ppl give up to 8mg in peripheral blocks). I have gotten ~5hrs of anesthesia and 24+ hrs of analgesia with this mix. Some ppl give a single large injection at paravertebral T4. Run a sedation drip of your throughout surgery and you're good to go. Sometimes surgeon supplements with local if the block hasn't quite set yet, which takes ~10 min.

If paravertebral block is impossible, my last resort would be to make damn sure that a thoracic epidural (making sure that it covers T1) is working properly before the surgeon makes his incision.

http://www.nysora.com/regional-anesthesia/4340-keys-to-success-with-peripheral-nerve-blocks.html
 
Pinkegg said:
Long time lurker here. So I have a patient who long story short doesn't want general for a node dissection. Anyone successfully perform regional for one of these? It's a tricky spot to cover depending on where the incision extends. I'm thinking interscalene vs thoracic epidural, possibly both, supplemented by the surgeon? Thoughts?
Click to expand...

I've had the same patient that really didn't want GA for the same procedure. After detailed explanations of the risks/benefits of any choice I'd make and what she'd likely experience, she decided she wanted GA.
 
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