RT Journal Article
SR Electronic
T1 P151 Breast reconstruction with diep free flap: spinal anesthesia, combined with fascial plane blocks, may lead to better outcomes
JF Regional Anesthesia & Pain Medicine
JO Reg Anesth Pain Med
FD BMJ Publishing Group Ltd
SP A200
OP A201
DO 10.1136/rapm-2024-ESRA.283
VO 49
IS Suppl 1
A1 Fabio, Costa
A1 Caris, Francesca De
A1 Pascarella, Giuseppe
A1 Calabrese, Mariangela
A1 Pierantoni, Laura
A1 Remore, Luigi Maria
A1 Tenna, Stefania
A1 Brunetti, Beniamino
YR 2024
UL http://rapm.bmj.com/content/49/Suppl_1/A200.2.abstract
AB 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 sideResults 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.Abstract P151 Figure 1 Different phases of the DIEP flap breast reconstruction