Mastectomy With Sentinel Lymph Node Biopsy Under Regional Anesthesia in a Patient With a History of Multiple Anaphylactic Episodes

We describe the case of a 55-year-old woman proposed for an elective unilateral mastectomy with sentinel node biopsy due to breast cancer. The patient has a history of four episodes of anaphylaxis, one of which occurred during the induction of general anesthesia and resulted in cardiorespiratory arrest, which was reversed with advanced life support. The intradermal tests confirmed allergy to propofol, all types of neuromuscular relaxants, ketorolac, acetylsalicylic acid, generic antibiotics, and iodinated contrast agents. Following a multidisciplinary discussion that included anesthesiology, gynecology, allergy and clinical immunology, and the patient, it was decided to perform a thoracic epidural block in combination with interpectoral and pectoserratus plane blocks for the surgery. The patient requested anxiolysis via music therapy. The procedure was uneventful, and the patient was transferred to the post-anesthetic care unit, where she remained under vigilance for 12 hours.