This Article Résumé de cet Article Full Text Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Buckenmaier, C. C. Articles by Klein, S. M. Search for Related Content PubMed PubMed Citation Articles by Buckenmaier, C. C., III Articles by Klein, S. M.

Paravertebral somatic nerve blocks for breast surgery in a patient with hypertrophic obstructive cardiomyopathy

[Les blocs paravertébraux des nerfs somatiques pour une intervention mammaire chez une patiente qui présente une cardiomyopathie obstructive]

From the Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA.

Address correspondence to: Dr. Chester C. Buckenmaier III, Department of Anesthesiology, Box 3094, Duke University Medical Center, Durham, North Carolina 27710, USA. Phone: 919-668-2053; Fax: 919-668-2081; E-mail: bucke001{at}mc.duke.edu

Purpose: Patients with hypertrophic obstructive cardiomyopathy (HOCM), a genetic disorder resulting in idiopathic myocardial thickening, can present the anesthesiologist with significant management difficulties. This report reviews the physiology of this important disease process and describes the use of paravertebral nerve blocks (PVB) in the management of a patient with HOCM who presented for partial mastectomy with axillary lymph node dissection.

Clinical features: A 72-yr-old female presented for breast cancer surgery with a significant past medical history of HOCM diagnosed during hospitalization for non-small cell lung cancer. PVB were performed at thoracic levels 1–6 and 5 mL of 0.5% ropivacaine and epinephrine 1:400,000 was injected at each level. Intraoperatively the patient required no other medication for analgesia and was comfortable and conversant during the two-hour procedure. She remained pain free following the operation and did not require any opioid medication until the following day.

Conclusions: PVB provide excellent analgesia and are a useful alternative anesthetic when faced with the HOCM patient requiring major breast surgery.

This article has been cited by other articles:

				P. F. White Choice of peripheral nerve block for inguinal herniorrhaphy: is better the enemy of good? Anesth. Analg., April 1, 2006; 102(4): 1073 - 1075. [Full Text] [PDF]