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Is additional epidural sympathetic block in microvascular surgery contraindicated? A preliminary report
R van Twisk1, M J Gielen, P W Pavlov
1Nijmegen University Hospital St Radboud, St Maartens Clinic-Nijmegen, The Netherlands.
British Journal of Plastic Surgery
|January 1, 1988
Summary
Epidural sympathetic blocks help prevent vasospasm in lower extremity microvascular surgery. However, bupivacaine via epidural catheter may reduce transplant perfusion due to its sympathectomy effect.
Area of Science:
- Anesthesiology
- Vascular Surgery
- Pharmacology
Background:
- Epidural sympathetic blocks are commonly used to prevent vasospasm during and after lower extremity microvascular surgery.
- Vasospasm remains a significant concern, potentially compromising graft survival.
Purpose of the Study:
- To evaluate the effect of epidural bupivacaine on transplant perfusion in lower extremity microvascular surgery.
- To investigate a potential adverse effect of epidural analgesia on graft perfusion.
Main Methods:
- Administration of bupivacaine (Marcain) via an epidural catheter during and after microvascular surgery.
- Monitoring of transplant perfusion rates.
Main Results:
- A significant decrease in transplant perfusion rate was observed following the administration of epidural bupivacaine.
- This reduction in perfusion has not been previously reported in the literature.
Conclusions:
- Epidural analgesia with bupivacaine may negatively impact transplant perfusion in lower extremity microvascular surgery.
- The observed effect is likely due to the sympathectomy induced by epidural bupivacaine, counteracting the intended benefits of vasospasm prevention.