A Modified Radical Mastectomy (MRM) In A 59-Year-Old Female Patient with Comorbid Bronchiectasis Using Thoracic Segmental Spinal Anesthesia (TSA)


  • Imam Ghozali
  • Hario Tri Hendroko
  • Dansen Rudyanto University of Lampung
  • Marcella Dena Fernanda




MRM, TSA, Regional anesthesia, modified radical mastectomy, thoracic segmental spinal anesthesia, regional anesthesia


Breast cancer is a disease with the highest incidence of malignancy in Indonesia and the world. Epidemiological studies have shown that cancer affects billions of women each year. The incidence of breast cancer increases with age. In the elderly, the possibility of co-morbidities which are comorbid major medical problems makes anesthetic management decisions more complicated and perioperative care more challenging. Increasing age and comorbidities are the most important risk factors for postoperative complications. TSA was performed on a 59-year-old female patient with comorbid bronchiectasis who received MRM. The level of needle insertion was between T5-T6, premedication in the form of 0.5 mg alprazolam tablets, initiation of TSA with 1 ml of 0.5% hyperbaric bupivacaine and 20 mcg of fentanyl. The level of sensory block achieved was between T1-T7. TSA resolved without complications. The patient remained comfortable during the operation and there was no significant change in the patient's hemodynamics, airway and breathing. There were no postoperative complications. Thoracal segmental spinal anesthesia (TSA) is a safe alternative in performing modified radical mastectomy (MRM) and other breast surgeries because it has highly selective spinal block capabilities, ensures better control during induction and surgical processes, stability of the respiratory system and cardiovascular, and reduces the need for local anesthetics and has a lower risk of toxicity.

Author Biographies

Imam Ghozali



Hario Tri Hendroko



Marcella Dena Fernanda




Burguin A, Diorio C. Burguin 2021. 2021;

Kemenkes RI. 2019. 2019. Penyakit Kanker di Indonesia Berada Pada Urutan 8 di Asia Tenggara dan Urutan 23 di Asia.

McLean RC, McCallum IJD, Dixon S, O’Loughlin P. A 15-year retrospective analysis of the epidemiology and outcomes for elderly emergency general surgical admissions in the North East of England: A case for multidisciplinary geriatric input. International Journal of Surgery. 2016; 28:13–21.

Vincenzi P, Stronati M, Isidori P, Iuorio S, Gaudenzi D, Boccoli G, et al. Opioid-Free Segmental Thoracic Spinal Anesthesia with Intrathecal Sedation for Breast and Axillary Surgery: Report of Four Cases. Local Reg Anesth. 2022;15(March):23–9.

Hajibandeh S, Hajibandeh S, Adasonla K, Antoniou SA, Barrie J, Madan M, et al. Loco-regional versus general anaesthesia for elective endovascular aneurysm repair - results of a cohort study and a meta-analysis. Vasa [Internet]. 2018;47(3):209–17. Available from: https://doi.org/10.1024/0301-1526/a000688

Imbelloni LE, Sakamoto JW, Viana EP, Araujo AA De, Pöttker D, Pistarino MDA. Segmental Spinal Anesthesia: A Systematic Review Journal of Anesthesia & Clinical Research. 2020;1–6.

Hopkins PM. Does regional anaesthesia improve outcome? Br J Anaesth. 2015; 115: ii26–33.

Sultan P, Halpern SH, Pushpanathan E, Patel S, Carvalho B. The Effect of Intrathecal Morphine Dose on Outcomes after Elective Cesarean Delivery: A Meta-Analysis. Anesth Analg. 2016;123(1):154–64.

Elakany M, Abdelhamid S. Segmental thoracic spinal has advantages over general anesthesia for breast cancer surgery. Anesth Essays Res. 2013;7(3):390.

Santhosh MCB, Bhat Pai R, Rao RP. Controle anestésico de nefrectomia em paciente com doença pulmonar obstrutiva crônica e pneumotórax espontâneo recorrente. Brazilian Journal of Anesthesiology. 2016;66(4):423–5.

Upadhya R K, Shenoy L, Venkateswaran R. Effect of intravenous dexmedetomidine administered as bolus or as bolus-plus-infusion on subarachnoid anesthesia with hyperbaric bupivacaine. J Anaesthesiol Clin Pharmacol. 2018;34(3):46–50.

Ramakrishna Rao A, Vijaya G, Mahendra VVN. Comparison of Effects of Preloading and Coloading with Ringer Lactate in Elective Caesarean Section Cases under Spinal Anaesthesia. IOSR Journal of Dental and Medical Sciences Ver II. 2015;14(10):2279–861.



How to Cite

Ghozali, I., Hendroko, H. T., Rudyanto, D., & Fernanda, M. D. (2023). A Modified Radical Mastectomy (MRM) In A 59-Year-Old Female Patient with Comorbid Bronchiectasis Using Thoracic Segmental Spinal Anesthesia (TSA). Medical Profession Journal of Lampung, 13(6), 1020-1024. https://doi.org/10.53089/medula.v13i6.831