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Ultrasound-Guided Midpoint Transverse Process to Pleura Block in Breast Cancer Surgery

A Case Report

Bhoi, Debesh, MBBS, MD; Narasimhan, Purnima, MBBS, MD; Nethaji, Ranjitha, MBBS, MD; Talawar, Praveen, MBBS, MD

doi: 10.1213/XAA.0000000000000850
Case Reports

To avoid the safety issues related to thoracic paravertebral blocks, we performed midpoint transverse process to pleura blocks in 3 patients before general anesthesia for modified radical mastectomies. The midpoint transverse process to pleura blocks served as the major component of multimodal analgesia. With ultrasound guidance, 7 mL of a mixture of 0.75% ropivacaine and 2% lidocaine with epinephrine were deposited at T2, T4, and T6 levels. We noted decreased sensation to cold and pinprick from T2 to T8 dermatome level with sparing of axilla and infraclavicular areas. The maximum pain numeric rating scale score (0–10) was 4 out on movement and none had mean 24-hour numeric rating scale >3.

From the Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India.

Accepted for publication June 11, 2018.

Funding: None.

The authors declare no conflicts of interest.

Address correspondence to Debesh Bhoi, MBBS, MD, FTA-205, 2nd Floor, Ayurvigyan Nagar, August Kranti Marg, New Delhi 110049, India. Address e-mail to

© 2019 International Anesthesia Research Society
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