Superficial parasternal intercostal plane block in awake breast surgery: A case report

Awake breast surgeries are gaining popularity, particularly for patients with high comorbidities or those seeking to avoid general anesthesia. Proper anesthesia management is essential for ensuring a smooth procedure and minimizing pain. This case report describes the anesthesia approach for a 74-year-old female patient undergoing right total mastectomy and axillary lymph node dissection due to a 4 cm breast mass. The patient had multiple comorbidities, including hypertension, diabetes, coronary artery disease, and severe chronic obstructive pulmonary disease. Regional anesthesia was administered using a combination of ultrasound-guided total paravertebral block (TPVB), interpectoral plane and pectoroserratus plane (IPP + PSP) blocks, and a superficial parasternal block. The patient reported minimal pain, with only slight discomfort during skin incision. The surgery was completed without complications, and the patient's pain scores remained low, with a Numeric Rating Scale (NRS) score of 2–3 in recovery. This case demonstrates the effectiveness of combining regional anesthesia techniques for awake breast surgery, providing adequate analgesia while reducing the need for opioids. The use of the parasternal block alongside TPVB and IPP + PSP blocks ensured comprehensive anesthesia coverage. Further research, including randomized controlled trials, is necessary to determine the most effective and reliable anesthesia techniques for awake breast surgery.