title: Epidural anesthesia as a thromboembolic prophylaxis modality in plastic surgery.
abstract: BACKGROUND
  Epidural anesthesia (EA) is known to reduce postoperative thromboembolic complications, but the mechanisms are poorly understood. Review of the literature revealed no reports about the ability of epidural anesthesia (EA) to reduce the risk of venous thromboembolism (VTE) in abdominal contouring surgery and/or liposuction. Most medical publications in this field are based on orthopedic cases.
  
  
  OBJECTIVE
  The authors investigate the hypothesis that the differential nerve-blocking effect of bupivacaine, which spares motor function and permits leg movement during the operation, is the most important mechanism by which EA prevents thromboembolism.
  
  
  METHODS
  From June 1992 to August 1995, 24 cases of abdominoplasty were performed under general anesthesia (Group 1). From September 1995 to December 2009, 371 cases of concurrent abdominoplasty and liposuction were performed under EA (Group 2). Eighteen cases (4.8%) from Group 2 were ultimately excluded from the study because of unsuccessful EA. All surgeries were performed by the senior author (FH).
  
  
  RESULTS
  One thromboembolic event (pulmonary embolism [PE]) occurred in Group 1 (4%). No cases of deep vein thrombosis (DVT) or PE occurred among Group 2 patients.
  
  
  CONCLUSIONS
  Together, differential epidural nerve blocks and purposeful intraoperative movement of lower-limb muscles represent an effective prophylactic mechanism that may prevent devastating DVT and resultant PE.
authors.affiliation: Tehran University of Medical Sciences, St. Fatima Hospital, Tehran, Iran. info@drhafezi.com
authors.forename: Farhad
authors.initials: F
authors.lastname: Hafezi
authors.forename: Bijan
authors.initials: B
authors.lastname: Naghibzadeh
authors.forename: Amir Hossein
authors.initials: AH
authors.lastname: Nouhi
authors.forename: Alireza
authors.initials: A
authors.lastname: Salimi
authors.forename: Ghazal
authors.initials: G
authors.lastname: Naghibzadeh
authors.forename: S Jaber
authors.initials: SJ
authors.lastname: Mousavi
mesh_terms: D000767:Anesthesia, Epidural / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use; D002045:Bupivacaine / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015187:Lipectomy / Q000009:adverse effects / Q000379:methods; D008297:Male; D009407:Nerve Block / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D054556:Venous Thromboembolism / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine