title: Epidural Combined with General Anesthesia versus General Anesthesia Alone in Patients Undergoing Free Flap Breast Reconstruction.
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.
  
  
  CONCLUSIONS
  Epidural anesthesia/general anesthesia combination improves postoperative pain and side effects without increasing the risk of flap thrombosis.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: 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.
authors.forename: Feifei
authors.initials: F
authors.lastname: Lou
authors.forename: Zhirong
authors.initials: Z
authors.lastname: Sun
authors.forename: Naisi
authors.initials: N
authors.lastname: Huang
authors.forename: Zhen
authors.initials: Z
authors.lastname: Hu
authors.forename: Ayong
authors.initials: A
authors.lastname: Cao
authors.forename: Zhenzhou
authors.initials: Z
authors.lastname: Shen
authors.forename: Zhimin
authors.initials: Z
authors.lastname: Shao
authors.forename: Peirong
authors.initials: P
authors.lastname: Yu
authors.forename: Changhong
authors.initials: C
authors.lastname: Miao
authors.forename: Jiong
authors.initials: J
authors.lastname: Wu
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural / Q000379:methods*; D000768:Anesthesia, General / Q000379:methods*; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery; D015331:Cohort Studies; D003131:Combined Modality Therapy; D019074:Epigastric Arteries / Q000601:surgery / Q000637:transplantation; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D010147:Pain Measurement; D010149:Postoperative Pain / Q000503:physiopathology / Q000517:prevention & control*; D061525:Perforator Flap / Q000098:blood supply / Q000637:transplantation*; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome