Continuous Thoracic Epidural Analgesia As An Adjunct To General Anaesthesia For Modified Radical Mastectomy : A Case Report

Abstract

Modified Radical Mastectomy (MRM) is associated with moderate to severe postoperative pain, which may impair respiratory function, delay mobilization and adversely affect recovery. Effective perioperative analgesia is therefore an important component of anaesthetic management. Thoracic epidural analgesia (TEA), when combined with general anaesthesia, provides effective analgesia and may reduce perioperative opioid requirements.  We present the case of a 73-year-old female with carcinoma of the right breast who underwent Modified Radical Mastectomy under general anaesthesia supplemented with thoracic epidural analgesia. A midline thoracic epidural catheter was inserted at the T6–T7 interspinous space. Following a successful test dose, an adequate bilateral thoracic sensory block was established. The relevant sensory distribution for breast and axillary surgery predominantly involves the T2–T6 dermatomes. Continuous epidural infusion of 0.5% ropivacaine at 4 mL/hour was initiated prior to induction of general anaesthesia. Intraoperative analgesia was supplemented with intravenous paracetamol infusion. The intraoperative period was haemodynamically stable, and the patient was extubated uneventfully. Postoperatively, epidural analgesia with 0.2% ropivacaine provided effective pain relief with blood pressure monitoring.   This case highlights the role of thoracic epidural analgesia as an effective component of multimodal analgesia in patients undergoing Modified Radical Mastectomy.