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array:24 [ "pii" => "S2341192918301860" "issn" => "23411929" "doi" => "10.1016/j.redare.2018.06.009" "estado" => "S300" "fechaPublicacion" => "2019-01-01" "aid" => "959" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "copyrightAnyo" => "2018" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2019;66:46-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0034935618301415" "issn" => "00349356" "doi" => "10.1016/j.redar.2018.06.009" "estado" => "S300" "fechaPublicacion" => "2019-01-01" "aid" => "959" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Rev Esp Anestesiol Reanim. 2019;66:46-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 422 "formatos" => array:2 [ "HTML" => 221 "PDF" => 201 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Caso clínico</span>" "titulo" => "Caso clínico: bloqueo serrato intercostal/BRILMA y sedación en mastectomía en paciente de riesgo" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "46" "paginaFinal" => "48" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Case report: serratus intercostal plane block/BRILMA and sedation for mastectomy in a high risk patient" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1015 "Ancho" => 1583 "Tamanyo" => 198348 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Bloqueo en el plano del serrato intercostal con aguja por encima de la costilla, inyectando anestésico local.</p> <p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">AL: anestésico local; MIC: músculos intercostales. 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"apellidos" => "Bustinza-Beaskoetxea" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2341192918301860" "doi" => "10.1016/j.redare.2018.06.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192918301860?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935618301415?idApp=UINPBA00004N" "url" => "/00349356/0000006600000001/v1_201812250607/S0034935618301415/v1_201812250607/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2341192918301872" "issn" => "23411929" "doi" => "10.1016/j.redare.2018.08.008" "estado" => "S300" "fechaPublicacion" => "2019-01-01" "aid" => "967" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2019;66:49-52" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Marfan syndrome in a term-pregnant woman with aortic root dilatation between 40 and 45<span class="elsevierStyleHsp" style=""></span>mm" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "49" "paginaFinal" => "52" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Síndrome de Marfan en gestante a término con dilatación de la raíz aórtica entre 40 y 45<span class="elsevierStyleHsp" style=""></span>mm" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "D.R. 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In addition to adequate monitoring, the surgical team must have access to the VAD screens to check that they are functioning correctly and providing a steady flow. Changes observed on the screens could indicate possible complications, the most frequent being kinking of the cannulas or hypovolaemia.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Albajar Bobes, M. Casado Salcedo, E. Rincón Gómez-Limón, J.M. Álvarez Avello, A.I. González Román, M. Vidal Fernández, A. Forteza Gil, M. Gómez-Bueno, J. Segovia Cubero, J. García Fernández" "autores" => array:10 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Albajar Bobes" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Casado Salcedo" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Rincón Gómez-Limón" ] 3 => array:2 [ "nombre" => "J.M." "apellidos" => "Álvarez Avello" ] 4 => array:2 [ "nombre" => "A.I." "apellidos" => "González Román" ] 5 => array:2 [ "nombre" => "M." "apellidos" => "Vidal Fernández" ] 6 => array:2 [ "nombre" => "A." "apellidos" => "Forteza Gil" ] 7 => array:2 [ "nombre" => "M." "apellidos" => "Gómez-Bueno" ] 8 => array:2 [ "nombre" => "J." "apellidos" => "Segovia Cubero" ] 9 => array:2 [ "nombre" => "J." "apellidos" => "García Fernández" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0034935618301373" "doi" => "10.1016/j.redar.2018.07.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935618301373?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192918301859?idApp=UINPBA00004N" "url" => "/23411929/0000006600000001/v1_201901100606/S2341192918301859/v1_201901100606/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Case report: Serratus intercostal plane block/BRILMA and sedation for mastectomy in a high risk patient" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "46" "paginaFinal" => "48" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "R. Sanllorente-Sebastián, J.M. de Vicente-Lorenzo, F.J. Mediavilla-Herrera, S. Gutiérrez-García, I.S. Alario-Poza, Z. Bustinza-Beaskoetxea" "autores" => array:6 [ 0 => array:4 [ "nombre" => "R." "apellidos" => "Sanllorente-Sebastián" "email" => array:1 [ 0 => "bibliotecas2010@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "J.M." "apellidos" => "de Vicente-Lorenzo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "F.J." "apellidos" => "Mediavilla-Herrera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "S." "apellidos" => "Gutiérrez-García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "I.S." "apellidos" => "Alario-Poza" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 5 => array:3 [ "nombre" => "Z." "apellidos" => "Bustinza-Beaskoetxea" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Departamento de Anestesia y Reanimación, Hospital Universitario de Burgos, Burgos, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Obstetricia y Ginecología, Hospital Universitario de Burgos, Burgos, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Caso clínico: bloqueo serrato intercostal/BRILMA y sedación en mastectomía en paciente de riesgo" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1015 "Ancho" => 1583 "Tamanyo" => 198040 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Intercostal serratus plane block with needle above the rib, injecting local anaesthetic. LA: local anaesthetic; ICM: intercostal muscles; Arrows: needle.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Breast cancer is one of the main causes of oncological surgery in elderly people, a procedure that is associated with moderate to severe pain. Regional analgesia can help limit postoperative pain and even avoid general anaesthesia when used in a multimodal regimen. Although the superiority of regional anaesthesia over general anaesthesia remains controversial, many anaesthesiologists prefer to reduce the risk of homeostatic alterations by avoiding general anaesthesia in elderly patients whenever possible, particularly in frail, polymedicated patients with comorbidities.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The intercostal serratus plane block, or BRILMA (in its Spanish acronym) is a new regional anaesthetic technique for breast and thoracic surgery that has shown promising results in the control of chronic and acute pain.</p><p id="par0015" class="elsevierStylePara elsevierViewall">We describe the use of BRILMA plus sedation as an anaesthetic technique for breast cancer surgery in a high-risk patient.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case report</span><p id="par0020" class="elsevierStylePara elsevierViewall">An 87-year old woman (weight 52<span class="elsevierStyleHsp" style=""></span>kg, height 154<span class="elsevierStyleHsp" style=""></span>cm, and BMI 21.93) was scheduled for mastectomy and sentinel node dissection due to malignancy. Her history was significant for insulin-dependent diabetes mellitus, chronic kidney failure with baseline creatinine of 1.7<span class="elsevierStyleHsp" style=""></span>mg/dl, atrial fibrillation and pacemaker. The latest echocardiogram had been performed 1 month before surgery, and revealed moderate mitral stenosis, severe mitral regurgitation, mild aortic insufficiency, moderate tricuspid regurgitation, and moderate pulmonary hypertension (similar to the previous echocardiogram). She had repeatedly refused valvular repair surgery, and was evaluated regularly by her cardiologist, and had a NYHA classification of II. Her treatment consisted of digoxin, warfarin and insulin.</p><p id="par0025" class="elsevierStylePara elsevierViewall">We proposed performing the surgery under regional anaesthesia using the intercostal serratus block (BRILMA), which is a superficial block and therefore less invasive. After considering the anaesthetic options, the patient gave her informed consent for BRILMA plus sedation, in order to avoid general anaesthesia as far as possible. The patient was monitored by electrocardiography, pulse oximetry and non-invasive blood pressure. Infusion for pre-puncture sedation was started with remifentanil and midazolam delivered by a calibrated device to achieve a Ramsay score of 3–4, which was maintained until the end of the surgery. Supplemental oxygen (2<span class="elsevierStyleHsp" style=""></span>L/min) was administered via nasal prongs. Ondansetron 4<span class="elsevierStyleHsp" style=""></span>mg was administered for nausea and vomiting prophylaxis.</p><p id="par0030" class="elsevierStylePara elsevierViewall">To perform the block, the patient was placed in the supine position with the left arm in 90° abduction and the table tilted to the right side by about 15°–20°. The intercostal serratus was identified between the serratus muscle and ribs by ultrasound imaging using a 12<span class="elsevierStyleHsp" style=""></span>MHz linear transducer (LOGIQe, GE Healthcare) placed on the mid-axillary line at level of the fourth rib. The subcutaneous tissue was identified in the superficial plane, the anterior serratus muscle, ribs and intercostal muscles in the intermediate plane, and the pleura and lung in the deep plane.</p><p id="par0035" class="elsevierStylePara elsevierViewall">An echogenic 80<span class="elsevierStyleHsp" style=""></span>mm needle (Stimuplex Ultra 360 BRAUN) was inserted in plane in a caudocranial direction from the caudal edge of the transducer. When the tip had reached the intercostal space of the fourth rib, and after negative aspiration, 14<span class="elsevierStyleHsp" style=""></span>ml of levobupivacaine 0.5% (Chirocaine, Abbvie) was injected under the serratus muscle without repositioning the needle, and the cranial and caudal spread of the anaesthetic was monitored (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Following this, 5<span class="elsevierStyleHsp" style=""></span>ml of levobupivacaíne 0.2% was infiltrated for subcutaneous blockade of the intercostobrachial nerve, 5<span class="elsevierStyleHsp" style=""></span>ml of levobupivacaine 0.1% was injected subcutaneously along the parasternal line to block the medial branches of the intercostal nerves, and 5<span class="elsevierStyleHsp" style=""></span>ml of levobupivacaíne 0.1% was injected subcutaneously to block the infraclavicular branches of the superficial cervical plexus. Paracetamol infusion was administered to complete the multimodal analgesic regimen.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">After 30<span class="elsevierStyleHsp" style=""></span>min, the sensory block was verified, and surgery was started by sedating the patient with remifentanil and midazolam to achieve a Ramsay score of 3–4 throughout the procedure. Forty-five minutes after the start of surgery, during dissection of the middle of the breast, 5<span class="elsevierStyleHsp" style=""></span>ml of local anaesthesia was injected by the surgeon to strengthen the blockade. No additional anaesthesia was needed. A specimen weighing 68<span class="elsevierStyleHsp" style=""></span>g was obtained. The sentinel lymph node biopsy was negative for metastasis.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Ninety minutes after the start of surgery the procedure was finalised and the patient was transferred to the postanaesthesia care unit (PACU). No additional analgesia was required. In accordance with PACU protocols, she was transferred to the hospital ward when the appropriate criteria had been met, 2<span class="elsevierStyleHsp" style=""></span>h after completing the surgery. There were no complications. In the ward she was given paracetamol 3 times daily, and did not report pain.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The patient gave her written consent for this case report to be published.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0055" class="elsevierStylePara elsevierViewall">The introduction of ultrasound allowed anaesthesiologists to reconsider existing nerve blocks and develop new approaches, including interfascial plane techniques such as PECS and intercostal serratus plane block.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">The intercostal serratus block, known as BRILMA, is a fascial block originally described by Fajardo et al.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> for cancer surgery, although it has also been used in thoracic surgery (thoracoscopy and thoracotomy).<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> Both acute and chronic chest pain can be treated with this regional technique,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a> and it has also been used to facilitate weaning from mechanical ventilation in critically ill patients.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a> A variation of this technique has been described for upper abdominal surgeries, such as cholecystectomies.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> Care must be taken to avoid pleural puncture and pneumothorax when performing the block, although it is performed in a more superficial plane than intercostal nerve block, and therefore is theoretically less risky. Real-time constant visualisation of the needle tip helps minimise this risk. Despite the potentially serious complications associated with this technique, none have been reported.</p><p id="par0065" class="elsevierStylePara elsevierViewall">In addition, BRILMA provides better haemodynamic stability than neuraxial blocks, since it does not cause autonomic block. It can also be used in patients treated with antiplatelet drugs, or with an abnormal coagulation profile.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">We found a report of BRILMA used for anaesthesia (not only analgesia) in a high-risk patient in combination with other fascial blocks (PECS block and parasternal injections of local anaesthetic), and propofol for sedation.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Although it has been widely used for analgesia in surgical procedures, there are few reports of surgery performed with BRILMA alone plus sedation.</p><p id="par0080" class="elsevierStylePara elsevierViewall">We have only found 1 report in which serratus intercostal plane block alone was used for excision due to previous localisation of a benign scar formation causing breast pain in a patient with morbid obesity. The patient received no other intra- or postoperative analgesia, and only propofol was administered for sedation.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">To our knowledge, this is the first report of mastectomy for breast cancer in a high-risk patient using BRILMA and sedation. The patient only complained of pain at the beginning of the dissection of the middle of the breast. In our experience, we have observed delayed onset of anaesthesia in the region of the sentinel ganglion, so we decided to reinforce the intercostobrachial nerve block subcutaneously. We also blocked the supraclavicular nerve from the superficial plexus for additional analgesia, because these branches innervate the breast,<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a> and BRILMA blocks the axillary space and the middle intercostal branches. This may not have been strictly necessary,<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">2,9</span></a> but as these are subcutaneous, low-risk nerve blocks, we decided to perform them to ensure sufficient residual analgesia.</p><p id="par0090" class="elsevierStylePara elsevierViewall">The intercostal serratus plane nerve block, or BRILMA, is a promising analgesia and anaesthesia technique in breast surgery; however, 1 case report is insufficient, and more clinical studies are needed to fully verify the effectiveness of the technique without general anaesthesia, and to determine the pharmokinetics, and the optimal volume and concentration of local anaesthetic to be used. Meta-analyses and systematic reviews will contribute to our understanding.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusion</span><p id="par0095" class="elsevierStylePara elsevierViewall">BRILMA is a new fascial block with a good safety profile that is relatively easy to perform by anaesthesiologists with experience in ultrasound guided techniques. It is a promising technique for surgical and non-surgical analgesia and anaesthesia, and has the advantage of reducing, or even avoiding, the need for general anaesthesia. It should be seriously considered in patients in whom opioid and hypnotic consumption must be reduced.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conflicts of interest</span><p id="par0100" class="elsevierStylePara elsevierViewall">None.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres1135247" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1067346" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1135248" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1067347" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conclusion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-03-16" "fechaAceptado" => "2018-06-29" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1067346" "palabras" => array:7 [ 0 => "Serratus intercostal" 1 => "Block" 2 => "Breast" 3 => "Cancer" 4 => "High risk" 5 => "Comorbidities" 6 => "Sedation" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1067347" "palabras" => array:7 [ 0 => "Serrato intercostal" 1 => "Bloqueo" 2 => "Mama" 3 => "Cáncer" 4 => "Alto riesgo" 5 => "Comorbilidades" 6 => "Sedación" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Breast cancer surgery can benefit from regional anaesthesia techniques, which can be used as a sole anaesthetic procedure in some cases where risk for general anaesthesia is high. Regional anaesthesia allows early recovery, reduces postoperative opioid and non opioid analgesics consumption and helps early home discharge, reducing thus costs. We present a case of an 87-year-old woman with multiple comorbidities who underwent breast cancer surgery. The patient was successfully surgically treated under serratus intercostal plane block anaesthesia. We discuss the use and benefits of the serratus intercostal plane block in thoracic procedures.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La cirugía del cáncer de mama puede beneficiarse de las técnicas de anestesia regional que pueden usarse como técnicas anestésicas únicas en algunos casos en los que el riesgo de la anestesia general para el paciente es alto. La anestesia regional permite una rápida recuperación, reduce el consumo de analgésicos opioides y no opioides postoperatorios ayudando al alta temprana, reduciendo costes. Presentamos el caso de una mujer de 87 años con múltiples comorbilidades que fue intervenida de cirugía de cáncer mamario. La paciente fue operada satisfactoriamente bajo anestesia mediante bloqueo serrato intercostal. Se discute el empleo y los beneficios de este bloqueo en procedimientos torácicos.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Sanllorente-Sebastián R, de Vicente-Lorenzo JM, Mediavilla-Herrera FJ, Gutiérrez-García S, Alario-Poza IS, Bustinza-Beaskoetxea Z. Caso clínico: bloqueo serrato intercostal/BRILMA y sedación en mastectomía en paciente de riesgo. Rev Esp Anestesiol Reanim. 2019;66:46–48.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1015 "Ancho" => 1583 "Tamanyo" => 198040 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Intercostal serratus plane block with needle above the rib, injecting local anaesthetic. LA: local anaesthetic; ICM: intercostal muscles; Arrows: needle.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bloqueo de las ramas cutáneas de los nervios intercostales (BRILMA) a nivel de la línea media axilar para cirugía no reconstructiva de mama" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Fajardo" 1 => "P. Diéguez" 2 => "S. López" 3 => "P. Alfaro" 4 => "F.J. 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