Effective postoperative analgesia using a single-shot intertransverse process block after mastectomy with immediate latissimus dorsi flap reconstruction: A case report

In mastectomy with immediate breast reconstruction using a latissimus dorsi flap (LDF), managing extensive postoperative pain from the anterior chest wall to the back remains challenging, and thoracic paravertebral block (TPVB) is an effective analgesic technique. However, because the surgical field for LDF harvest may extend close to the spine, preoperative block techniques and catheter placement can be difficult as a result of potential interference with the operative field and concerns regarding surgical site infection. In addition, when TPVB is performed postoperatively, sonographic visibility of deep structures may be compromised, potentially increasing the risk of complications. Here, we report a case in which a single-shot intertransverse process block (ITPB) was performed after mastectomy with immediate LDF breast reconstruction. A woman in her 50s was scheduled for mastectomy and immediate breast reconstruction with an LDF. Surgery was performed under general anesthesia combined with a single-shot postoperative ITPB. The Numerical Rating Scale (NRS) score at emergence was 1/10 and remained 1–2/10 postoperatively, and she was discharged without any issues. ITPB is expected to provide analgesia similar to that of TPVB and may be associated with a lower risk of complications because the target site is relatively superficial. When TPVB is difficult to perform for analgesia in immediate breast reconstruction, ITPB may be a useful alternative option.