Epidural anesthesia as a thromboembolic prophylaxis modality in plastic surgery

Area of Science:

• Anesthesiology
• Vascular Surgery
• Plastic Surgery

Background:

• Epidural anesthesia (EA) is recognized for reducing postoperative thromboembolic complications, yet the underlying mechanisms remain unclear.
• Limited research exists on EA's efficacy in preventing venous thromboembolism (VTE) specifically within abdominal contouring and liposuction procedures.
• Existing literature predominantly focuses on orthopedic applications of EA for VTE prevention.

Purpose of the Study:

• To test the hypothesis that EA's selective nerve blockade, preserving motor function and enabling leg movement, is key to preventing thromboembolism.
• To evaluate the effectiveness of EA in preventing VTE during abdominoplasty and liposuction surgeries.

Main Methods:

• A retrospective study comparing 24 abdominoplasty cases under general anesthesia (Group 1) with 371 concurrent abdominoplasty and liposuction cases under EA (Group 2).
• Exclusion of 18 cases (4.8%) from Group 2 due to failed EA.
• All procedures were performed by the senior author.

Main Results:

• One case of pulmonary embolism (PE) occurred in Group 1 (4% incidence).
• No instances of deep vein thrombosis (DVT) or PE were recorded in Group 2 patients who underwent EA.
• This indicates a significant reduction in VTE events with EA.

Conclusions:

• Differential epidural nerve blocks, combined with intentional intraoperative leg muscle activation, serve as a potent prophylactic strategy against VTE.
• This approach may effectively prevent severe deep vein thrombosis (DVT) and subsequent pulmonary embolism (PE) in patients undergoing cosmetic surgery.