Paravertebral Block for Enhanced Recovery after Nonintubated Video-assisted Thoracoscopic Surgery Wedge Resection in a Patient with Breast Cancer and Bronchiectasis
Year: 2025
Type: article
Study design: Case Report
Abstract: The implementation of enhanced recovery after surgery (ERAS) protocols has led to increased interest in nonintubated video-assisted thoracoscopic surgery (NIVATS), especially in patients with compromised pulmonary function. We present a case of a 62-year-old female with stage IIIA breast cancer and pulmonary bronchiectasis who underwent right-sided wedge resection via NIVATS. A two-level thoracic paravertebral block (TPVB) at T4 and T6 using 0.4% isobaric bupivacaine with epinephrine was performed, resulting in sensory block from T2 to T7. An intrathoracic vagal block with 0.5% bupivacaine was administered to prevent cough. Sedation was maintained with dexmedetomidine and remifentanil. Surgery lasted 83 minutes with no complications. Postoperatively, pain was minimal (NRS 0–2), the patient mobilized within 6 hours and was discharged the next day. This case highlights the feasibility and safety of TPVB-based NIVATS in a high-risk patient, aligning with ERAS goals of enabling early recovery, avoiding airway instrumentation and minimizing opioid use.
Authors: Danya P. Chan, Peñafrancia C. Cano, Joselle C. Pua
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W4412519744