Combination of thoracic segmental spinal anesthesia and erector spinae plane block for modified radical mastectomy: A case report

A 49-year-old female patient presented to the hospital with a lump in the right breast, which she had first noticed ten months ago. Fine needle aspiration cytology reported infiltrating ductal carcinoma. The patient requested a different anesthetic modality other than general anesthesia. We had planned to perform a right-sided modified radical mastectomy with axillary lymph node dissection. We provided thoracic segmental spinal anesthesia along with an erector spinae plane block for the surgical procedure. The erector spinae plane block was performed at the level of the right T4 transverse process with a 23G Quincke needle and 60 mg of levobupivacaine (0.25%). Thoracic segmental spinal anesthesia was administered at the T4 - T5 interspace using a 27G Quincke needle, injecting 6 mg levobupivacaine 0.5% mixed with 25 mcg of Fentanyl. The sensory block from C8 to T7 was tested by the pinprick method. The patient was hemodynamically stable throughout surgery and showed adequate postoperative analgesia, as evident from an excellent visual analog score. This case demonstrates that thoracic segmental spinal anesthesia combined with an erector spinae plane block is a good alternative for general anesthesia in modified radical mastectomy with a lower complication rate and satisfactory analgesia.