Thoracic Epidural Anesthesia (TEA) with 0.2 % Ropivacaine

Background: Breast cancer is the 2nd most common tumors in Thai women. Until now, oncologic breast surgeries are typically performed by general anesthesia (GA). However, GA cannot provide adequate post-operative pain control and routine use of parenteral opioids aggravate postoperative sedation, nausea, emesis, impaired oxygenation and depressed ventilation. Thoracic epidural anesthesia (TEA) is one of the regional anesthetic techniques that can be done by using a low dose of local anesthetic in combination with ipsilateral brachial plexus block (BPB) for axillary node dissection. TEA can provide a better pain relief without potential paralysis of respiratory muscle and sedation. Material and Method: Fifty ASA PS I-III patients undergoing MRM were randomly assigned to two study groups of 25 patients each. In the TEA group, an epidural catheter was inserted at T4 to T5, and 10-15 ml of 0.2 % ropivacaine was injected, then interscalene BPB was done with 8 ml of 0.2 % ropivacaine. Anesthesia was maintained with 5-10 ml of 0.2 % ropivacaine per hour. GA was induced with 1 µg/kg of fentanyl followed by 1.5-2 mg/kg of propofol and was maintained with sevoflurane and 70 % N2O in oxygen. The authors evaluated the adequacy of anesthesia, surgical condition, postanesthetic recovery, postanesthetic analgesia and patients ’ satisfaction. Results: The demographic data was similar in both groups. The number of patients immediately arrived a