Single-shot lamina thoracic paravertebral block with ketofol for modified radical mastectomy

Ambrose Rukewe,1 Oludolapo O Afuwape,2 Austin Ugheoke,3 Akinola A Fatiregun4 1Department of Anaesthesia & Critical Care, Faculty of Medicine, University of Botswana, Gaborone, Botswana; 2Department of Surgery, College of Medicine, 3Department of Anaesthesia, University College Hospital, Ibadan, 4World Health Organisation, Akure, Ondo State, Nigeria Abstract: We describe the use of single-shot lamina thoracic paravertebral block (TPVB) with sedation for a 56-year-old female patient who had modified radical mastectomy with axillary clearance. Two years ago, she suffered vocal cord palsy post thyroidectomy, which was managed with tracheostomy. The tracheostomy tube was removed 8 months later, leaving the patient with persistent hoarseness of voice and left vocal cord palsy. She declined general anesthesia and consented for TPVB. The surgery lasted 95 minutes and was successfully completed with TPVB. Her vital signs were stable during the operation. She had low pain scores, minimal opioid use, early alimentation, and no postoperative nausea and vomiting and was discharged early. We present the anesthetic management of this case in our setting, where TPVB under ultrasound guidance and modern drug-delivery systems for sedation are unavailable. Keywords: anesthesia, breast surgery, lamina, paravertebral, low resourc