Feifei Lou1, Zhirong Sun, Naisi Huang, Zhen Hu, Ayong Cao, Zhenzhou Shen, Zhimin Shao, Peirong Yu, Changhong Miao, Jiong Wu. 1. Shanghai, People's Republic of China; and Houston, Texas From the Departments of Anesthesiology and Breast Surgery, Fudan University Shanghai Cancer Center, and the Department of Oncology, Shanghai Medical College, Fudan University; and the Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center.
Abstract
BACKGROUND: Addition of epidural anesthesia may have several benefits. The purpose of this study was to investigate the effectiveness and safety of epidural anesthesia combined with general anesthesia in patients undergoing free flap breast reconstruction. METHODS: A retrospective chart review identified 99 patients who underwent free flap breast reconstruction under general anesthesia alone (46 patients) or general anesthesia plus epidural anesthesia (53 patients) between 2011 and 2014. Mean arterial blood pressure was measured before induction, after flap elevation but before flap transfer, 15 minutes after flap revascularization, and at the end of surgery. Postoperative pain was assessed using a visual analogue scale. RESULTS: The incidence of flap thrombosis was 3.8 percent in the epidural anesthesia/general anesthesia group versus 4.3 percent in the general anesthesia group (p = 1). Flap failure was 0 percent in the epidural anesthesia/general anesthesia group versus 4.3 percent in the general anesthesia group (p = 0.213). Patients in the epidural anesthesia/general anesthesia group had lower visual analogue scale scores at 2 hours (0.76 ± 0.62 versus 2.58 ± 0.99; p < 0.001), 6 hours (1.94 ± 1.19 versus 4.04 ± 1.46; p < 0.001), and 24 hours (0.74 ± 0.69 versus 1.56 ± 1.01; p < 0.001) postoperatively. Mean arterial blood pressure was lower in the epidural anesthesia/general anesthesia group after flap elevation but before flap transfer, 15 minutes after flap revascularization, and at the end of surgery. CONCLUSION: Epidural anesthesia/general anesthesia combination improves postoperative pain and side effects without increasing the risk of flap thrombosis. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
BACKGROUND: Addition of epidural anesthesia may have several benefits. The purpose of this study was to investigate the effectiveness and safety of epidural anesthesia combined with general anesthesia in patients undergoing free flap breast reconstruction. METHODS: A retrospective chart review identified 99 patients who underwent free flap breast reconstruction under general anesthesia alone (46 patients) or general anesthesia plus epidural anesthesia (53 patients) between 2011 and 2014. Mean arterial blood pressure was measured before induction, after flap elevation but before flap transfer, 15 minutes after flap revascularization, and at the end of surgery. Postoperative pain was assessed using a visual analogue scale. RESULTS: The incidence of flap thrombosis was 3.8 percent in the epidural anesthesia/general anesthesia group versus 4.3 percent in the general anesthesia group (p = 1). Flap failure was 0 percent in the epidural anesthesia/general anesthesia group versus 4.3 percent in the general anesthesia group (p = 0.213). Patients in the epidural anesthesia/general anesthesia group had lower visual analogue scale scores at 2 hours (0.76 ± 0.62 versus 2.58 ± 0.99; p < 0.001), 6 hours (1.94 ± 1.19 versus 4.04 ± 1.46; p < 0.001), and 24 hours (0.74 ± 0.69 versus 1.56 ± 1.01; p < 0.001) postoperatively. Mean arterial blood pressure was lower in the epidural anesthesia/general anesthesia group after flap elevation but before flap transfer, 15 minutes after flap revascularization, and at the end of surgery. CONCLUSION: Epidural anesthesia/general anesthesia combination improves postoperative pain and side effects without increasing the risk of flap thrombosis. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.