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

Samiksha Punekar; Akhilesh Parihar; Amreesh Paul

doi:10.31893/multiscience.2026059

Keywords:

segmental spinal anesthesia

modified radical mastectomy

postoperative analgesia

breast cancer

Abstract

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.
References
1. Azmy, A. M., Abdelrahman, A. H., Badwy, F. A., Mahmoud, W. A., & Taha, A. H. M. (2021). Erector Spinae Plane Block: Review Article. The Egyptian Journal of Hospital Medicine, 84(1), 2591–2598. https://doi.org/10.21608/ejhm.2021.188558
2. Harbeck, N., Penault-Llorca, F., Cortes, J., Gnant, M., Houssami, N., Poortmans, P., Ruddy, K., Tsang, J., & Cardoso, F. (2019). Breast cancer. Nature Reviews Disease Primers, 5(1), 66. https://doi.org/10.1038/s41572-019-0111-2
3. Li, H., Shen, Q., Zhou, X., & Shen, X. (2021). Analgesic effects of erector spinae plane block for patients after breast surgery: A systematic review and meta-analysis. Journal of International Medical Research, 49(3), 030006052199956. https://doi.org/10.1177/0300060521999568
4. Liu, H., & Luo, C. (2022). Effect of breast-conserving surgery and modified radical mastectomy on quality of life of early breast cancer patients. Food Science and Technology, 42, e47021. https://doi.org/10.1590/fst.47021
5. Luftig, J., Mantuani, D., Herring, A. A., Dixon, B., Clattenburg, E., & Nagdev, A. (2018). Successful emergency pain control for posterior rib fractures with ultrasound-guided erector spinae plane block. The American Journal of Emergency Medicine, 36(8), 1391–1396. https://doi.org/10.1016/j.ajem.2017.12.060
6. Malawat, A., Verma, K., Jethava, D., & Jethava, D. (2020). Erector spinae plane block for complete surgical anaesthesia and postoperative analgesia for breast surgeries: A prospective feasibility study of 30 cases. Indian Journal of Anaesthesia, 64(2), 118. https://doi.org/10.4103/ija.IJA_639_19
7. Paul, A., & Borkar, A. (2023). Anaesthetic management for mastectomy in a male with unilateral gynecomastia: The utilization of thoracic segmental spinal anaesthesia and erector spinae plane block. Cureus, 15(10), e47502. https://doi.org/10.7759/cureus.47502
8. Shatri, G., & Singh, A. (2023). Thoracic segmental spinal anesthesia. Treasure Island (FL): StatPearls Publishing, 6.
9. Sherwin, A., & Buggy, D. J. (2018). Anaesthesia for breast surgery. BJA Education, 18(11), 342–348. https://doi.org/10.1016/j.bjae.2018.08.002
10. Smolarz, B., Nowak, A. Z., & Romanowicz, H. (2022). Breast Cancer—Epidemiology, Classification, Pathogenesis and Treatment (Review of Literature). Cancers, 14(10), 2569. https://doi.org/10.3390/cancers14102569
11. Solakovic, N. (2010). Level of sensory block and baricity of bupivacaine 0.5% in spinal anesthesia. Medicinski Arhiv, 64(3), 158–160.

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How to cite

Punekar, S., Parihar, A., & Paul, A. (2025). Combination of thoracic segmental spinal anesthesia and erector spinae plane block for modified radical mastectomy: A case report. Multidisciplinary Science Journal, 8(1), 2026059. https://doi.org/10.31893/multiscience.2026059

[1] Azmy, A. M., Abdelrahman, A. H., Badwy, F. A., Mahmoud, W. A., & Taha, A. H. M. (2021). Erector Spinae Plane Block: Review Article. The Egyptian Journal of Hospital Medicine, 84(1), 2591–2598. https://doi.org/10.21608/ejhm.2021.188558

[2] Harbeck, N., Penault-Llorca, F., Cortes, J., Gnant, M., Houssami, N., Poortmans, P., Ruddy, K., Tsang, J., & Cardoso, F. (2019). Breast cancer. Nature Reviews Disease Primers, 5(1), 66. https://doi.org/10.1038/s41572-019-0111-2

[3] Li, H., Shen, Q., Zhou, X., & Shen, X. (2021). Analgesic effects of erector spinae plane block for patients after breast surgery: A systematic review and meta-analysis. Journal of International Medical Research, 49(3), 030006052199956. https://doi.org/10.1177/0300060521999568

[4] Liu, H., & Luo, C. (2022). Effect of breast-conserving surgery and modified radical mastectomy on quality of life of early breast cancer patients. Food Science and Technology, 42, e47021. https://doi.org/10.1590/fst.47021

[5] Luftig, J., Mantuani, D., Herring, A. A., Dixon, B., Clattenburg, E., & Nagdev, A. (2018). Successful emergency pain control for posterior rib fractures with ultrasound-guided erector spinae plane block. The American Journal of Emergency Medicine, 36(8), 1391–1396. https://doi.org/10.1016/j.ajem.2017.12.060

[6] Malawat, A., Verma, K., Jethava, D., & Jethava, D. (2020). Erector spinae plane block for complete surgical anaesthesia and postoperative analgesia for breast surgeries: A prospective feasibility study of 30 cases. Indian Journal of Anaesthesia, 64(2), 118. https://doi.org/10.4103/ija.IJA_639_19

[7] Paul, A., & Borkar, A. (2023). Anaesthetic management for mastectomy in a male with unilateral gynecomastia: The utilization of thoracic segmental spinal anaesthesia and erector spinae plane block. Cureus, 15(10), e47502. https://doi.org/10.7759/cureus.47502

[8] Shatri, G., & Singh, A. (2023). Thoracic segmental spinal anesthesia. Treasure Island (FL): StatPearls Publishing, 6.

[9] Sherwin, A., & Buggy, D. J. (2018). Anaesthesia for breast surgery. BJA Education, 18(11), 342–348. https://doi.org/10.1016/j.bjae.2018.08.002

[10] Smolarz, B., Nowak, A. Z., & Romanowicz, H. (2022). Breast Cancer—Epidemiology, Classification, Pathogenesis and Treatment (Review of Literature). Cancers, 14(10), 2569. https://doi.org/10.3390/cancers14102569

[11] Solakovic, N. (2010). Level of sensory block and baricity of bupivacaine 0.5% in spinal anesthesia. Medicinski Arhiv, 64(3), 158–160.

Abstract

References

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