Abstract: Epidural Nerve Blocks Increase Intraoperative Vasopressor Consumption and Delay Surgical Start Time Compared to General Anesthesia Alone in DIEP Free Flap Breast Reconstruction
Notice bibliographique
Résumé
PURPOSE: The use of epidural anesthesia (EA) as an adjunct to general anesthesia (GA) has been widely used in abdominal and thoracic surgeries, and recently shown efficacy in autologous breast reconstruction.1–3 While the utility of reducing postoperative narcotic consumption, nausea, and length-of-stay in hospital cannot be understated, concerns remain as to the whether these blocks reduce operating room efficiency by delaying case start time and whether block-induced hypotension is associated with increased intraoperative vasopressor requirements. The purpose of this study was to examine the effectiveness of epidural blocks in patients undergoing deep inferior epigastric perforator (DIEP) flap breast reconstruction. METHODS: A retrospective analysis from 2015–2017 of patients who underwent DIEP flap reconstruction under GA, with and without EA and no supplementary local anesthetic. Electronic records were analyzed for patient demographics, intraoperative data, and postoperative outcomes. Primary outcome was 48-hour narcotic usage. Secondary outcomes were intraoperative vasopressor consumption, surgical delay time, and safety. RESULTS: Fifty-one patients underwent DIEP reconstruction, 40(78%) underwent EA in addition to GA, and 11(22%) underwent GA alone. There was a significant delay in OR start time in the EA/GA group (67min vs 43min, p=0.001.) Patients in the EA/GA group also had a statistically significant increase in vasopressor use (n=33 vs n=5, p=0.021). Postoperatively, patients who received an epidural block had a reduced average pain score (1 vs 2, p=0.05), but there was no difference in 48-hour narcotic usage. CONCLUSION: Epidural blocks improve average postoperative pain, while increasing intraoperative vasopressor use and delaying the start time of the case. The benefits of improved pain control must continue to be weighed against the potential for increased surgical complications, as well as increased costs to the health care system. REFERENCES: 1. Pei, Lijian, et al. “Ultrasound-assisted thoracic paravertebral block reduces intraoperative opioid requirement and improves analgesia after breast cancer surgery: a randomized, controlled, single-center trial.” PloS one 10.11 (2015): e0142249. 2. Zhong, Toni, et al. “Transversus abdominis plane (TAP) catheters inserted under direct vision in the donor site following free DIEP and MS-TRAM breast reconstruction: a prospective cohort study of 45 patients.” Journal of Plastic, Reconstructive & Aesthetic Surgery 66.3 (2013): 329–336. 3. Lou, Feifei, et al. “Epidural combined with general anesthesia versus general anesthesia alone in patients undergoing free flap breast reconstruction.” Plastic and reconstructive surgery 137.3 (2016): 502e-509e.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,000 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».