Pectoral nerve II block, transversus thoracic muscle plane block, and dexmedetomidine for breast surgery in a patient with achondroplasia: a case report

BACKGROUND: Patients with achondroplasia have various airway deformations and spinal anatomic abnormalities; therefore, performing general anesthesia and neuraxial anesthesia in such patients can be challenging. CASE PRESENTATION: A 56-year-old, 112-cm, 30-kg woman was scheduled to undergo partial mastectomy and sentinel lymph node biopsy for cancer of the right breast. She had short limbs, scoliosis, thorax deformation, and chronic moderate to severe mitral regurgitation of the mitral valve. We performed pectoral nerve II block and transversus thoracic muscle plane block and administered intravenous dexmedetomidine. The surgery was completed without the administration of any additional analgesics or sedatives. CONCLUSIONS: We successfully performed breast surgery using pectoral nerve II block, transversus thoracic muscle plane block, and sedation with dexmedetomidine in a patient with achondroplasia. We found that the combination of peripheral nerve blocks is a useful option in patients who have difficulties with both general anesthesia and neuraxial anesthesia.