Multiple-Level Retrolaminar Block can Provide Effective Analgesia in Nipple-Sparing Mastectomy with Latissimus Dorsi Flap Reconstruction: A Report of Two Cases
Hiroshi Aoki *
Department of Anesthesia, Nagasaki Rosai Hospital, 2-12-5 Setogoe, Sasebo City, Nagasaki 857-0134, Japan.
Yoshiaki Terao
Department of Anesthesia, Nagasaki Rosai Hospital, 2-12-5 Setogoe, Sasebo City, Nagasaki 857-0134, Japan.
Ekuko Fujimoto
Department of Anesthesia, Nagasaki Rosai Hospital, 2-12-5 Setogoe, Sasebo City, Nagasaki 857-0134, Japan.
Makito Oji
Department of Anesthesia, Nagasaki Rosai Hospital, 2-12-5 Setogoe, Sasebo City, Nagasaki 857-0134, Japan.
Natsuko Oji
Department of Anesthesia, Nagasaki Rosai Hospital, 2-12-5 Setogoe, Sasebo City, Nagasaki 857-0134, Japan.
Hiroki Iwanaga
Department of Anesthesia, Nagasaki Rosai Hospital, 2-12-5 Setogoe, Sasebo City, Nagasaki 857-0134, Japan.
Tetsuya Hara
Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki 852-8501, Japan.
*Author to whom correspondence should be addressed.
Abstract
Aims: Nipple-sparing mastectomy with latissimus dorsi flap reconstruction (NMLR) may cause moderate to severe postoperative pain. Herein, two cases in which multiple-level RLB injections provided good analgesia for two patients who underwent NMLR are reported. Thoracic paravertebral block (TPVB) is recommended as the first-line regional analgesic technique for breast cancer surgery. Multiple-level TPVBs may provide effective analgesia for NMLR but may increase the risk of complications. A retrolaminar block (RLB), a known alternative to a TPVB, has a lower risk of complications and multiple-level RLB injections may be safely performed.
Presentation of Cases: NMLR was planned for two patients with breast cancer. Multiple-level RLB injections were administered for postoperative pain management. In both cases, the numerical rating scale scores measured at rest were low postoperatively, suggesting that multiple-level RLB injections effectively managed postoperative pain. Adequate analgesia was achieved using multiple-level RLB injections without additional drug administration in both patients.
Discussion and Conclusion: Multiple-level RLB injections may be widely used as appropriate dosages of local anesthetics are considered.
Keywords: Retrolaminar block, postoperative pain, latissimus flap breast reconstruction, multiple-level injections