THORACIC PARAVERTEBRAL BLOCK FOR BREAST SURGERY IN A PATIENT WITH PATENT FORAMEN OVALE, BIDIRECTIONAL SHUNT, AND SEVERE PULMONARY ARTERY HYPERTENSION: A CASE REPORT
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Abstract
Thoracic paravertebral block (PVB) is a regional anesthetic technique that provides effective analgesia and anesthesia for unilateral breast surgeries. Patients with severe pulmonary artery hypertension (PAH) and patent foramen ovale (PFO) with bidirectional shunt are at high risk from general anesthesia (GA) due to risk of right heart failure and paradoxical embolism.
**Case Presentation:** A 27-year-old female with severe PAH, bidirectional PFO, and left breast abscess requiring wide local excision was managed using ultrasound-guided left thoracic paravertebral block at T4–T5 and T5–T6 levels. The procedure provided adequate surgical anesthesia, stable hemodynamics, and excellent postoperative analgesia without opioid use.
**Conclusion:** Thoracic PVB can be a safe and effective anesthetic method in high-risk patients with severe PAH and PFO undergoing unilateral breast surgery where GA may pose significant risks.
References
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Radhika G
Junior Resident, Department of anesthesiology, Travancore medical College Hospital, Kollam 691020, Kerala, India