What happened, in summary

An 80-year-old woman had right breast adenocarcinoma diagnosed 4 years before surgery. She initially declined treatment and was followed with observation. The cancer later became exposed at the body surface and began bleeding, and her hemoglobin fell from 13.8 to 9.2 g/dL, so surgery was planned for local control. The breast cancer was classified as clinical Stage IIIB, with no metastasis at that time. Her medical condition made standard surgery difficult. She had bronchiectasis and interstitial pneumonia, could not lie flat because of severe shortness of breath, and lived in a semirecumbent or sitting position. Even conversation triggered wet cough and dyspnea. Because general anesthesia carried substantial pulmonary risk, the team planned right partial mastectomy rather than radical surgery and used regional anesthesia, local anesthesia, and sedation. Intertransverse process block was selected to numb the affected side while limiting respiratory-muscle effects and reducing pneumothorax risk. Ropivacaine was injected at T2/3 through T5/6, and dexmedetomidine sedation was used during the operation. Additional lidocaine with epinephrine was given locally when she felt pain near the mammary gland and pectoralis muscle. Surgery lasted 104 minutes, anesthesia lasted 143 minutes, oxygen saturation remained 92%-99% on low-flow oxygen, and dyspnea did not worsen. She went to the intensive care unit after surgery, transferred to the ward the next day, and was discharged on postoperative day 7 without complications. Her preoperative oxygen saturation was 92% on room air, and blood gas testing showed low oxygen with mild carbon dioxide retention, reinforcing the decision to avoid general anesthesia when possible.