Combined thoracic segmental spinal anaesthesia and erector spinae plane block with indwelling catheters for breast tumour surgery in selected high-risk patients: A case series

ABSTRACT

Breast tumour surgeries are conventionally performed under general anaesthesia (GA). However, in high-risk patients with significant comorbidities, GA may increase perioperative morbidity. Thoracic segmental spinal anaesthesia (TSSA) combined with erector spinae plane (ESP) block may provide effective surgical anaesthesia and prolonged postoperative analgesia. We present a case series of five female patients undergoing breast tumour surgeries under combined TSSA and ultrasound-guided ESP block with indwelling catheter placement. Procedures included modified radical mastectomy, breast-conserving surgery, lumpectomy, and mastectomy. TSSA was administered at the T4–T5 level using low-dose isobaric levobupivacaine, while ESP catheters were inserted under ultrasound guidance at the same thoracic level. Adequate surgical anaesthesia was achieved in all patients without need for conversion to GA. The combination of TSSA and ESP block with continuous catheter analgesia appears to be a feasible and effective regional anaesthesia technique for breast tumour surgery in selected high-risk patients.