Epidural Combined with General Anesthesia versus General Anesthesia Alone in Patients Undergoing Free Flap Breast Reconstruction

Plast Reconstr Surg. 2016 Mar;137(3):502e-509e. doi: 10.1097/01.prs.0000479933.75887.82.

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.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anesthesia, Epidural / methods*
  • Anesthesia, General / methods*
  • Breast Neoplasms / pathology
  • Breast Neoplasms / surgery
  • Cohort Studies
  • Combined Modality Therapy
  • Epigastric Arteries / surgery
  • Epigastric Arteries / transplantation
  • Female
  • Follow-Up Studies
  • Graft Rejection
  • Graft Survival
  • Humans
  • Mammaplasty / adverse effects
  • Mammaplasty / methods*
  • Mastectomy / methods
  • Middle Aged
  • Monitoring, Intraoperative / methods
  • Pain Measurement
  • Pain, Postoperative / physiopathology
  • Pain, Postoperative / prevention & control*
  • Perforator Flap / blood supply
  • Perforator Flap / transplantation*
  • Postoperative Nausea and Vomiting / prevention & control
  • Retrospective Studies
  • Statistics, Nonparametric
  • Treatment Outcome