Introduction:

The word tumescent is derived from Latin term “Tumere” meaning to swell field block using tumescent
solution for cystosarcoma phyllodes of the breast can be done by blocking.

It is an excellent local anesthesia technique for high risk patients with heart diseases, respiratory disease
and cerebrovascular disease.

Case history:
A70 years old female weighing 85kg diagnosed to have cystosarcoma phyllodes on the right breast, she
was diagnosed newly as diabetic, Ischemic heart disease, echo report shows aortic stenosis with Left
Ventricular Ejection Fraction (LVEF) - 37% and patient is in congestive cardiac failure. Posted for
excision of the tumor patient was assessed under ASA Grade III.

In sitting position thoracic epidural was performed using 16G epidural catheter entry was made at the
level of T7 probably catheter tip was kept @74 back up for Ing. Fentanyl 25mcg was given.

In 450ml Ringer’s lactate bottle 30ml 2% lignocaine, adrenaline 1mg followed by 7.5% sodium
bicarbonate 10ml and hyaluronidase 500IU are added such that one milliliter contains 1.2mg of
lignocaine & adrenaline 2mcg (1 in 500000 dilution) and tumescent solution were prepared. Later patient
was connected on monitor to measure patient’s heart rate , blood pressure, SPO2 and electro cardiogram
Later block was given under aseptic precaution total of 250ml of tumescent solution was used and block
was achieved. Aster infiltration patient was sedated with Ing. Midazolam 1mg IV.

Intra operative was uneventful post operatively patient was monitored for any charges in Hemodynamic
and VAS score for analgesia. Adequate analgesia of VAS score of <4 was maintained for up to 15 hours.

Tumescent filed block is an excellent anesthesia technique where subarachnoid block is better avoided
line in patient with

1. Poor cardiac status with section fraction between 30 to 40 %

2. Patient with poor respiratory Reserve line COPD and Restrictive pulmonary disease
3. Patients recovering from hemiplegia with residual hemiparesis & old age patients
Advantage of tumescent solutions is because of its large volume available for infiltration to cover
surgical area and will be sufficient enough to provide good complete anesthesia. The total dose of
lignocaine can be go up to 35 -55 mg/kg. It provides good plane separation & less bleeding.

Conclusion:
Tumescent field block provide complete and safe analgesia in patient with cardiac disease with poor
Ejection Fraction (EF) to prevent further worsening because of pain due to incomplete analgesia.