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

Feifei, Lou; Sun, Zhirong; Huang, Naisi; Hu, Zhen; Cao, A-Yong; Shen, Zhenzhou; Shao, Zhimin; Yu, Peirong; Miao, Changhong; Wu, Jiong

doi:10.1097/01.prs.0000479933.75887.82

Cited by 17 publications

(11 citation statements)

References 19 publications

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“…The role of epidural anesthesia in DIEP free flap breast reconstruction remains unclear. Lou et al 19 demonstrated that epidural anesthesia improved postoperative pain, nausea/vomiting, and decreased opioid consumption without increasing the risk of flap thrombosis. Furthermore, other authors argue that epidural blocks induce vasodilation and therefore improve flap perfusion and oxygenation.…”

Section: Discussionmentioning

confidence: 99%

Epidural Nerve Blocks Increase Intraoperative Vasopressor Consumption and Delay Surgical Start Time in Deep Inferior Epigastric Perforator Free Flap Breast Reconstruction

Cormier

Stein

Zhang

et al. 2019

Plastic and Reconstructive Surgery - Global Open

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Background: Epidural nerve blocks (EA) have been widely used in abdominal and thoracic surgery as an adjunct to general anesthesia (GA). The role for EA in microsurgical free flap breast reconstruction remains unclear with concerns regarding its impact on flap survival and operating room efficiency. The purpose of this study was to examine the effectiveness of epidural blocks in patients undergoing deep inferior epigastric perforator (DIEP) flap breast reconstruction. Methods: A retrospective analysis of patients undergoing DIEP breast reconstruction under GA alone was compared with those receiving EA/GA. Electronic records were analyzed for patient demographics, intraoperative data, and postoperative outcomes. The primary outcome was 48-hour narcotic usage and secondary outcomes were intraoperative vasopressor consumption, surgical delay, and safety profile. Results: Sixty-one patients underwent DIEP reconstruction, 46 (75%) underwent EA/GA and 15 (25%) underwent GA alone. Epidural blocks were associated with a significant delay in operating room start time (67.8 min versus 45.6 min; P = 0.0004.) Patients in the EA/GA group also had a significant increase in vasopressor use (n = 38 versus n = 8; P = 0.037); however, there was no difference in flap complication rate [1 (2%) versus 2 (13%); P = 0.15]. Postoperatively, patients who received an epidural block had a reduced average pain score (1.1 versus 2.2; P = 0.0235), but there was no difference in 48-hour narcotic usage. Conclusions: Although epidural blocks reduce postoperative pain following DIEP flap breast reconstruction, they increase intraoperative vasopressor use and delay the start time of the case. Further studies are required to elucidate whether the benefits of improved pain control outweigh the potential risk for increased surgical complications and increased health care costs.

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Section: Discussionmentioning

confidence: 99%

Epidural Nerve Blocks Increase Intraoperative Vasopressor Consumption and Delay Surgical Start Time in Deep Inferior Epigastric Perforator Free Flap Breast Reconstruction

Cormier

Stein

Zhang

et al. 2019

Plastic and Reconstructive Surgery - Global Open

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“…The well-known methods for anesthesia or analgesia objective in breast cancer surgery are TEB, TPVB, and INCB, etc. [ 3 4 5 ]. Compared to conventional regional anesthesia, Pecs block is a less invasive procedure with easier techniques and lesser risk of complications.…”

Section: Discussionmentioning

confidence: 99%

Surgical excision of the breast giant fibroadenoma under regional anesthesia by Pecs II and internal intercostal plane block: a case report and brief technical description: a case report

Kim

Shim

Kim

2017

Korean J Anesthesiol

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A 22-years-old female patient at 171 cm and 67 kg visited the Department of Breast Surgery of the hospital with a mass accompanied with pain on the left side breast as chief complaints. Since physical examination revealed a suspected huge mass, breast surgeon decided to perform surgical excision and requested anesthesia to our department. Surgery of breast tumor is often under local anesthesia. However, in case of big size tumor, surgery is usually performed under general anesthesia. The patient feared general anesthesia. Unlike abdominal surgery, there is no need to control visceral pain for breast and anterior thoracic wall surgery. Therefore, we decided to perform resection under regional anesthesia. Herein, we report a successful anesthetic and pain management of the patient undergoing excision of a huge breast fibroadenoma under regional anesthesia using Pecs II and internal intercostal plane block.

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“…Pain following open-heart surgery could be debilitating, leading to unwanted outcomes such as pulmonary complications [14]. In most study cases, TEA with GA relates to better post-surgery analgesia and lower risks of post-operative respiratory system complications, moreover it helps lowering inflammation [15,16]. Controversially, other study findings states that the addition of epidural anaesthesia to GA doesn't show any less risk in developing major medical complications or mortality rates in long-term and both anaesthesia methods are appropriate [17,18].…”

Section: Discussionmentioning

confidence: 99%

Post-Operative Chest X-Ray Findings and Temporal Lung Changes in Relation to Anaesthesia Method Performed During Open-Heart Surgeries With Cardiopulmonary Bypass

Mačys,

Vasiukevičiūtė,

Lenkutis

2022

Health Sciences

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Aim. To evaluate and assess the role of anaesthesia type in the development of lung X-ray changes after open-heart surgery. Methods. This is a retrospective study. During the period of 2019 11–2021 06, 287 patients underwent open-heart surgery with general anaesthesia (GA) (230 patients) or thoracic epidural analgesia with general anaesthesia (TEA + GA) (57 patients). We have collected data of patients’ X-rays that were performed on the first and the fifth day after the surgery. Results. There is a statistically significant relation that patients who received TEA + GA developed more changes of venous stasis (p<0.05) in lungs X-ray on the first day post-surgery. Other findings revealed that following surgery, all the chest X-ray changes were detected more frequent in patients who had GA vs. TEA + GA performed. Nevertheless, these results didn’t show statistical significance (p>0.05). Conclusions. The study reveals that there is a difference between anaesthesia method used for the development of abnormal pulmonary X-ray findings. The study shows that people who received TEA + GA were more prone to developing venous stasis post-surgery.

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

Abstract: Therapeutic, III.

Cited by 17 publications

References 19 publications

Epidural Nerve Blocks Increase Intraoperative Vasopressor Consumption and Delay Surgical Start Time in Deep Inferior Epigastric Perforator Free Flap Breast Reconstruction

Epidural Nerve Blocks Increase Intraoperative Vasopressor Consumption and Delay Surgical Start Time in Deep Inferior Epigastric Perforator Free Flap Breast Reconstruction

Surgical excision of the breast giant fibroadenoma under regional anesthesia by Pecs II and internal intercostal plane block: a case report and brief technical description: a case report

Post-Operative Chest X-Ray Findings and Temporal Lung Changes in Relation to Anaesthesia Method Performed During Open-Heart Surgeries With Cardiopulmonary Bypass

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