Thoracic epidural anesthesia for perioperative anesthesia and post-operative analgesia in a patient posted for modified radical mastectomy: A case report

Abstract

Modified radical mastectomy is usually performed under general anesthesia, but patients with significant comorbidities or difficult airways face higher perioperative risks. Thoracic epidural anesthesia (TEA) provides a safer alternative by ensuring effective surgical anesthesia, superior analgesia, and stable hemodynamics. We report the case of a 65-year-old female with invasive ductal carcinoma and multiple comorbidities, uncontrolled diabetes, hypertension, coronary artery disease, and previous difficult weaning after general anesthesia, who underwent modified radical mastectomy with TEA. The epidural was placed at T8, achieving a C7 block, and dexmedetomidine infusion was used for sedation. The 180-min procedure was completed under TEA with spontaneous ventilation and stable hemodynamics, without complications. Epidural analgesia provided excellent post-operative pain control. TEA, especially when supplemented with dexmedetomidine, is an effective and safe alternative to general anesthesia for high-risk patients, minimizing airway and hemodynamic risks while enhancing recovery.