Radical Mastectomy Under Spinal Anaesthesia

By:Dr. Nitin C Kotwal

(nckotwal@gmail.com)

Introduction

• Practicing this technique since last 15 years.

• Study of 350 cases till date

• Age group- 30-80 yrs. (ASA I to IV )

Technique

• Preloading with crystalloids, inj. Rantac & inj. Zofer

• Same as Spinal Anaesthesia

• L3-L4 interspace

• Drug: Sensorcaine (Heavy) 0.5%

• Quantity of drug: 2.5-3 ml

• Needle no. 27 (LP needle)

• No additional analgesia or additives required

• Mild sedation may be used in anxious or apprehensive patients.

Complications

• Bradycardia

• Hypotension

• Post spinal headache

• Missing Dermatome 11% 10%

1%1%

76%

Complications PercentageBradycardia (<60) Hypotension (< 70)Post spinal headache Dermatomae missingNo Cognizeble side effects

Advantages

• No extra skill required• Can be practiced at periphery with ease • No absolute contraindications except those unfit for

routine spinal anaesthesia.• Bilaterally effective single dose • Reduced complications during and after the surgery• Decreased morbidity• Prolonged analgesia• No incidence of high spinal• Cost efficacy

What is different?

• Tilt (30-35 D head low position)

• Slow administration of the drug ( >2 min)

• Level of analgesia/ anaesthesia upto T2

Case Studies

Case 1

• 44 years old female, ASA II• Posted for left radical mastectomy

Case1_video

Case 2

• 62 year old female, ASA II• Posted for left radical mastectomy

Case2 Video

Case 3

• 38 year old female, ASA II• Posted for left radical mastectomy

Case3 Video