title: Paravertebral somatic nerve blocks for breast surgery in a patient with hypertrophic obstructive cardiomyopathy.
abstract: OBJECTIVE
  Patients with hypertrophic obstructive cardiomyopathy (HOCM), a genetic disorder resulting in idiopathic myocardial thickening, can present the anesthesiologist with significant management difficulties. This report reviews the physiology of this important disease process and describes the use of paravertebral nerve blocks (PVB) in the management of a patient with HOCM who presented for partial mastectomy with axillary lymph node dissection.
  
  
  METHODS
  A 72-yr-old female presented for breast cancer surgery with a significant past medical history of HOCM diagnosed during hospitalization for non-small cell lung cancer. PVB were performed at thoracic levels 1-6 and 5 mL of 0.5% ropivacaine and epinephrine 1:400,000 was injected at each level. Intraoperatively the patient required no other medication for analgesia and was comfortable and conversant during the two-hour procedure. She remained pain free following the operation and did not require any opioid medication until the following day.
  
  
  CONCLUSIONS
  PVB provide excellent analgesia and are a useful alternative anesthetic when faced with the HOCM patient requiring major breast surgery.
authors.affiliation: Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA. bucke001@mc.duke.edu
authors.forename: Chester C
authors.initials: CC
authors.lastname: Buckenmaier
authors.forename: Susan M
authors.initials: SM
authors.lastname: Steele
authors.forename: Karen C
authors.initials: KC
authors.lastname: Nielsen
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Klein
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000601:surgery*; D002312:Cardiomyopathy, Hypertrophic / Q000150:complications*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D015412:Mastectomy, Segmental; D009407:Nerve Block; D010102:Oxygen Inhalation Therapy; D010147:Pain Measurement; D021701:Sentinel Lymph Node Biopsy