P151 Breast reconstruction with diep free flap: spinal anesthesia, combined with fascial plane blocks, may lead to better outcomes
Bibliographic record
Abstract
Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page) Background and Aims After radical mastectomy, many patients undergo breast reconstruction. Autologous flap reconstruction avoids many issues despite being longer and complex. The DIEP (deep-inferior-epigastric-perforator) flap is the most common procedure, involving the transfer of skin and subcutaneous fat from the abdomen to the chest. The procedure takes many hours and requires optimal intraoperative analgesia and hemodynamic stability. Flap perfusion may benefit from spontaneous breathing. We considered spinal anesthesia with fascial-plane-blocks an alternative to general anesthesia to improve outcomes and recovery. Methods A 59-year-old woman (history of breast cancer, mastectomy, failed breast implant reconstruction) scheduled for reconstruction with DIEP flap. After signing informed consent and premedication with midazolam and atropine, spinal anesthesia and bilateral inter-transverse-process block (ITP) were performed. For spinal anesthesia at T10 with 27G needle, we administered 5 ml of ropivacaine 2mg/ml, fentanyl 20 mcg, and dexmedetomidine 5 mcg. For ITP block at T7: 30 ml of ropivacaine 0.2% and dexamethasone 4 mg each side Results The 7-hour surgery was conducted under moderate sedation with propofol. No bradycardia occurred; moderate hypotension was corrected with ephedrine. Mean arterial pressure remained stable. Oxygenation was maintained with O2 via nasal cannula. Additional fentanyl was administered at the end of surgery. The patient awakened pain-free and was monitored for flap perfusion and oxygenation for 24 hours; began early refeeding and mobilization without pain or nausea and was discharged home earlier. Conclusions High-volume/high-level spinals with adjuvants can be valid alternatives to epidural and general anesthesia for long-duration procedures like DIEP flap breast reconstruction. Trials are needed to evaluate advantages.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.010 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".