Single Needle Thoracic Paravertebral Block with Ropivacaine and Dexmeditomidine for Radical Mastectomy: Experience in 25 Cases

Background: Currently regional technique like thoracic paravertebral block for breast surgery is gaining a lot of popularity. As it produces unilateral action thereby minimal hemodynamic changes with autonomic blockade, allows early ambulation, facilitates postoperative analgesia, eliminate the risks/complications of general anaesthesia and thus reduces the hospital stay and cost. Aims and Objectives: We aim to present an observational prospective study to evaluate single needle continuous thoracic paravertebral block as a sole anaesthetic technique using ropivacaine 0.5% 20 ml with an adjuvant 0.5 mcg/Kg of dexmeditomidine in 25 females undergoing modified radical mastectomy. Methods: Following thorough evaluation, Informed consent and necessary OT preparations, thoracic paravertebral space was detected using 18G Tuohy needle at the level of T 4 on the operative side in sitting position. Epidural catheter was passed 2-3 cm inside the paravertebral space and patient was made supine. Following test dose of 3 ml 1.5% lignocaine with adrenaline, 20 ml (2 ml/segment) of 0.5% ropivacaine with 0.5 mcg/kg dexmeditomidine injected through the catheter. Results: All the patients had good to excellent surgical anaesthesia. No significant hemodynamic changes noted. Four patients required IV fentanyl 0.5-1 mcg/kg for mild discomfort intraoperatively. The level of sedation was adequate with minimal side effects. Conclusion: Single needle continuous thoracic paravertebral block using ropivacaine 0.5% with dexmeditomidine 0.5 mcg/kg as a sole anesthetic technique provided satisfactory surgical anaesthesia with minimal hemodynamic changes and adverse effects in 25 cases of radical mastectomies.