Thoracic Epidural Anesthesia for Mastectomy / 대한마취과학회지

ABSTRACT

BACKGROUND: Segmental thoracic epidural anesthesia (sTEA) is commonly used for postoperative pain control in chest or upper abdominal surgery. But it is not commonly used for the purpose of pure regional anesthesia. Therefore we investigated the usefulness of sTEA for mastectomy and evaluated the effects of sTEA on respiration and hemodynamics. METHODS: Twenty patients scheduled for mastectomy were randomly assigned. Under sitting position, epidural catheter was inserted at T3-4 or T4-5. 20 ml of 0.375% ropivacaine with fentanyl 50 microg was injected to maintain anesthesia. The targeted sensory anesthetic dermatomal levels were determined by pinprick and measured at 5 min intervals for the first 15 min after injection of the drugs. If sensory block was not adequate, subsequent 5 ml doses of ropivacaine was injected. Supplemental oxygen (3-6 L/min) was administered through a face mask. After dermatomal level was checked, propofol infusion for sedation was started. Arterial blood sampling was taken for ABGA. RESULTS: Average sensory anesthetic dermatomal levels is C5.5 +/- 1.9 - T8.9 +/- 2.7. During surgery, hypotension was noted in 25% of patients. It was treated with ephedrine 6 mg i.v. Average PaCO2 is 47.9 +/- 7.7 mmHg. CONCLUSIONS: Above results suggest that sTEA is suitable for mastectomy as a method of regional anesthesia.