title: DIEP Flap for Breast Reconstruction Using Epidural Anesthesia with the Patient Awake.
abstract: BACKGROUND
  Many articles have been published about breast reconstruction using the deep inferior epigastric perforator (DIEP) flap; however, few articles have been published in plastic/reconstructive surgery journals describing the difference between anesthetic techniques and recovery in microsurgical patients.
  
  
  METHODS
  We analyzed 16 patients who underwent DIEP flap for breast reconstruction. Patients were divided into 2 groups: group 1: general anesthesia (n = 9); group 2: epidural block with the patient awake (n = 7). In group 2, the peridural block was done at 2 levels: thoracic (T2-T3) and lumbar (L2-L3).
  
  
  RESULTS
  The success rate was 100% with no partial or total loss of the flap. There was no difference between groups in regard to postoperative pain in the first 5 days (Visual Analog Scale). Analgesia used in group 1 was buprenorphine and ketorolac, and in group 2, only ketorolac without opioid derivatives. Immediate postoperative recovery was better in the peridural group than in the group administered general anesthesia (P = 0.0001).
  
  
  CONCLUSIONS
  DIEP flap with peridural block and the patient awake during surgery is a feasible technique with better recovery in the immediate postoperative period, achieving good analgesia level with minimal intravenous medication.
authors: Divisions of Plastic and Reconstructive Surgery and Anesthesiology, Mexican Institute of Social Security (IMSS), Monterrey, Nuevo León, México.
authors: Miguel
authors: M
authors: de la Parra
authors: Divisions of Plastic and Reconstructive Surgery and Anesthesiology, Mexican Institute of Social Security (IMSS), Monterrey, Nuevo León, México.
authors: Marco
authors: M
authors: Camacho
authors: Divisions of Plastic and Reconstructive Surgery and Anesthesiology, Mexican Institute of Social Security (IMSS), Monterrey, Nuevo León, México.
authors: Jonatan
authors: J
authors: de la Garza