Multiple-Level Retrolaminar Block can Provide Effective Analgesia in Nipple-Sparing Mastectomy with Latissimus Dorsi Flap Reconstruction: A Report of Two Cases

Aims: Nipple-sparing mastectomy with latissimus dorsi flap reconstruction (NMLR) may cause moderate to severe postoperative pain. Herein, two cases in which multiple-level RLB injections provided good analgesia for two patients who underwent NMLR are reported. Thoracic paravertebral block (TPVB) is recommended as the first-line regional analgesic technique for breast cancer surgery. Multiple-level TPVBs may provide effective analgesia for NMLR but may increase the risk of complications. A retrolaminar block (RLB), a known alternative to a TPVB, has a lower risk of complications and multiple-level RLB injections may be safely performed.

Presentation of Cases: NMLR was planned for two patients with breast cancer. Multiple-level RLB injections were administered for postoperative pain management. In both cases, the numerical rating scale scores measured at rest were low postoperatively, suggesting that multiple-level RLB injections effectively managed postoperative pain. Adequate analgesia was achieved using multiple-level RLB injections without additional drug administration in both patients.

Discussion and Conclusion: Multiple-level RLB injections may be widely used as appropriate dosages of local anesthetics are considered.