title: The effect of epidural anaesthesia on peripheral resistance and graft flow following femorodistal reconstruction.
abstract: OBJECTIVE
  To determine the extent to which epidural anaesthesia influences peripheral resistance and graft blood flow following femorocrural reconstruction.
  
  
  METHODS
  Prospective, controlled study measuring blood flow, arterial pressure and peripheral resistance in femorocrural bypass grafts for 20 min following onset of epidural anaesthesia with 15ml of 0.25% bupivacaine.
  
  
  METHODS
  Twenty patients undergoing femorocrural reconstruction for critical lower-limb ischaemia with in situ long saphenous vein, under general anaesthesia. Ten patients had epidural cannulae inserted preoperatively and injected with bupivacaine after completion of the graft.
  
  
  RESULTS
  Peripheral resistance fell in all 10 patients receiving epidural anaesthesia from a mean (range) of 1.07 PRU (0.32-2.2) to 0.49 PRU (0.19-0.72), compared to control values of 0.95 PRU (0.39-2.0) to 0.91 PRU (0.41-1.51; P < 0.01, Wilcoxon). There was a tendency for blood pressure to fall in the study patients (not significant) but graft blood flow still increased from 98 ml min-1 (41-221) to 160 ml min-1 (101-250), compared to flow in the control patients of 101 ml min-1 (45-176) at baseline to 104 ml min-1 (56-168; p < 0.01) at 20 min.
  
  
  CONCLUSIONS
  Epidural anaesthesia significantly decreases peripheral resistance and increases graft blood flow in femorocrural grafts and would appear, therefore, to be of benefit for patients undergoing femorodistal reconstruction.
authors.affiliation: Department of Surgery, Queen Elizabeth Hospital, Edgbaston, Birmingham, U.K.
authors.forename: N C
authors.initials: NC
authors.lastname: Hickey
authors.forename: M P
authors.initials: MP
authors.lastname: Wilkes
authors.forename: D
authors.initials: D
authors.lastname: Howes
authors.forename: J
authors.initials: J
authors.lastname: Watt
authors.forename: C P
authors.initials: CP
authors.lastname: Shearman
mesh_terms: D000368:Aged; D000767:Anesthesia, Epidural; D001166:Arteriovenous Shunt, Surgical; D002045:Bupivacaine; D016022:Case-Control Studies; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D007511:Ischemia / Q000503:physiopathology / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D008297:Male; D011446:Prospective Studies; D012039:Regional Blood Flow / Q000502:physiology; D012501:Saphenous Vein / Q000637:transplantation*; D014655:Vascular Resistance / Q000502:physiology
chemical_list: D002045:Bupivacaine