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DIEP Flap for Breast Reconstruction Using Epidural Anesthesia with the Patient Awake
Miguel de la Parra1, Marco Camacho1, Jonatan de la Garza1
1Divisions of Plastic and Reconstructive Surgery and Anesthesiology, Mexican Institute of Social Security (IMSS), Monterrey, Nuevo León, México.
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.
