Key result
Combined ESP and serratus-intercostal blocks with ketamine-dexmedetomidine enable effective opioid-free anesthesia in a multimorbid patient.
Why the study?
Multimorbidity increases the risk of perioperative and postoperative complications, and tailored anaesthetic management using peripheral nerve and fascial blocks could minimise negative outcomes and avoid general anaesthesia complications.
Case Report (n=1)
No
Fascial blocks combined with opioid-free anesthesia using ketamine and dexmedetomidine may provide safe and effective perioperative management for multimorbid patients undergoing breast surgery.
May support opioid-free anesthesia in multimorbid breast surgery patients; hypothesis-generating and requires prospective validation.
Multimorbidity is a clinical presentation that poses an increased risk of perioperative and postoperative complications. Tailored anaesthetic management could potentially minimise the risk of negative outcomes. Peripheral nerve and fasciae blocks are valid strategies for perioperative and postoperative pain management, which avoid complications related to general anaesthesia and reduce the risk of intensive care unit admission as well as the hospital length of stay. We describe the case of a 56-old patient with multimorbidity, including obesity with a BMI of 45.7, unstable angina, predicted difficult airway management and obstructive sleep apnoea syndrome (OSAS) scheduled for left mastectomy with sentinel lymph node biopsy, managed with a left continuous thoracic erector spinae plane (ESP) block plus serratus-intercostal plane block (BRanches of Intercostal nerves at the Level of Mid-Axillary line (BRILMA)), and sedation with combined ketamine-dexmedetomidine. Fascial blocks combined with opioid-free anaesthesia (OFA) proved to be effective for the multimorbid patient, ensuring successful perioperative management and a proper recovery after surgery.
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D'Agostino et al. (2023) conducted a case report in Suspected breast cancer with multimorbidity (n=1). Continuous erector spinae plane (ESP) block plus serratus-intercostal plane block (BRILMA) with ketamine-dexmedetomidine sedation was evaluated on Postoperative pain and complications. The combination of continuous erector spinae plane and serratus-intercostal plane blocks with ketamine-dexmedetomidine sedation provided effective opioid-free anesthesia and postoperative pain control without complications in a multimorbid patient.
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