General anesthesia combined with thoracic epidural anesthesia: an anesthesia technique option in modified radical mastectomy

I Gusti Ayu Eka Para Santi Sidemen, Tjokorda Gde Agung Senapathi, I Made Gede Widnyana, I Gusti Ngurah Mahaalit Aribawa, Christopher Ryalino

I Gusti Ayu Eka Para Santi Sidemen
Departemen Anestesi dan Terapi Intensif FK UNUD - RSUP Sanglah

Tjokorda Gde Agung Senapathi
Udayana University

I Made Gede Widnyana

I Gusti Ngurah Mahaalit Aribawa

Christopher Ryalino
. Email:
Online First: July 09, 2019 | Cite this Article
Sidemen, I., Senapathi, T., Widnyana, I., Aribawa, I., Ryalino, C. 2019. General anesthesia combined with thoracic epidural anesthesia: an anesthesia technique option in modified radical mastectomy. Bali Journal of Anesthesiology 3. DOI:10.15562/bjoa.v3i0.128

The incidence of breast cancer has been increasing, and currently, it is the most common cancer in females. Surgery is the primary treatment, and the current tendency is toward less extensive procedure with axillary dissection for removal of lymph nodes to guide further treatment, in this case, the method called modified radical mastectomy (MRM).  The anesthetic technique for MRM should provide adequate intraoperative anesthesia, muscle relaxation, and postoperative analgesia without collateral effects, nausea, and vomiting with the minimum hospitalization time. In this report, we present a case of a woman who underwent MRM under general anesthesia combined with thoracic epidural anesthesia.


Sundarathiti P, Pasutharnchat K, Kongdan Y, Suranutkarin PE. Thoracic Epidural Anesthesia (TEA) with 0,2% Ropivacaine in Combination with Ipsilateral Brachial Plexus Block (BPB) for Modified Radical Mastectomy (MRM). J Med Assoc Thai. 2005; 88(4): 513-20. DOI:

Bhardwaj A, Singh B, Singh AP. Comparative study between thoracic epidural and general anesthesia for modified radical mastectomy. Indian Journal of Clinical Anesthesia, 2017;4(1): 13-15. DOI: 10.18231.

Asegaonkar BN, Zine SR, Takalkar UV, et al. Thoracic epidural anesthesia for modified radical mastectomy in carcinoma of breast patient with chronic obstructive pulmonary disease: A case report. International Journal of Case Reports and Images. 2013;4(10):546-50. DOI: 10.5348/ijcri-2013-10-376-CR-5.

Rajan R, Gosavi SN, Ninave S. Upper Thoracic Epidural vs General Anaesthesia for MRM surgeries. International Journal of Biomedical Research. 2016;7(10):718-20. DOI: 10.7439/ijbr.

Oktavia E. A comparative Study between Thoracic Epidural Anesthesia and General Anesthesia for Patients Who Underwent Modified Radical Mastectomy with Axillary Lymph Node Dissection in De La Salle University Medical Center. Indones Biomed J. 2015;7(2):111-6. DOI: 10.18585/inabj.v7i2.77.

Yeh CC, Yu JC, Wu CT, et al. Thoracic Epidural Anesthesia for Pain Relief and Postoperation Recovery with Modified Radical Mastectomy. World J. Surg. 1999;23(3).256-61. DOI: 10.1007/PL00013180.

Hiremath VR. Thoracic Epidural Anesthesia for Modified Radical Mastectomy in Type 2 Diabetes Mellitus Patient. J of Evolution of Med and Dent Sci. 2014;3(70):15002-6. DOI: 10.14260/jemds/2014/4017.

Belzarena SD. Comparative Study between Thoracic Epidural Block and General Anesthesia for Oncologic Mastectomy. Rev Bras de Anestesiol. 2008;58(6):561-8. Available from:

Ravi PR, Jaiswal P. Thoracic Epidural Analgesia for Breast Oncological Procedures: A Better Alternative to General Anesthesia. Journal of Marine Medical Society. 2017; 19(2): 91-5. DOI: 10.4103/jmms.jmms_57_17.

Rajesh V. Comparative evaluation of thoracic epidural anesthesia and general anesthesia during the modified radical mastectomy. International Journal of Medical and Health Research. 2018; 4(2):154-7.

Etta OU, Udeme N. Thoracic epidural for modified radical mastectomy in a high-risk patient. Malawi Medical Journal. 2017;29(1);61-2. Available from:

R Devi U, KR Kumar V, Aasthaa A, et al. Modified radical mastectomy for intraductal breast carcinoma in a patient with active pulmonary tuberculosis under thoracic epidural anesthesia. Int J Med Res Rev. 2016;4(7):1216-20. DOI: 10.17511/ijmrr.2016.i07.24.

Ahmed AM, Ali H, Helai O, et al. Comparative Study between Continous Thoracic Epidural vs Thoracic Spinal Anaesthesia in Breast Surgery. J Pain Relief . 2018;6(4):292. DOI: 10.4172/2167-0846.1000292.

Fresie H, Aken HK. Risk and benefits of thoracic epidural anaesthesia. British Journal of Anaesthesia. 2011;107(6): 859-68. DOI: 10.1093/bja/aer339.

Chan KKM, Welch KJ. Cardiac Arrest during Segmental Thoracic Epidural Anesthesia. American Society of Anesthesiologist, Inc. 1997;86:503-5.

S Lahiry, DN Sharma, M Mund, et al. Thoracic epidural versus general anaesthesia for MRM surgeries. Int J Med and Dent Sci. 2016; 5(2). 1125-31. DOI:10.19056/ijmdsjssmes/2016/v5i2/100592.

Cheng GS, Ilfeld BM. A review of postoperative analgesia for breast cancer surgery. Pain Management. 2016. DOI: 10.2217/pmt-2015-0008.

No Supplementary Material available for this article.
Article Views      : 15
PDF Downloads : 0