Strategies in Trauma and Limb Reconstruction

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VOLUME 19 , ISSUE 1 ( January-April, 2024 ) > List of Articles


The Effect of Regional Anaesthesia on Free Flap Survival in Lower Extremity Reconstructions

Isabelle TS Koster, Matthijs M den Os, Martin VH Rutten, Thibault RI van den Dungen, Tim de Jong, Hay AH Winters, Caroline Driessen

Keywords : Flap survival, Free flaps, Lower extremity, Peripheral nerve block, Regional anaesthesia

Citation Information : Koster IT, den Os MM, Rutten MV, van den Dungen TR, de Jong T, Winters HA, Driessen C. The Effect of Regional Anaesthesia on Free Flap Survival in Lower Extremity Reconstructions. 2024; 19 (1):15-20.

DOI: 10.5005/jp-journals-10080-1612

License: CC BY-NC 4.0

Published Online: 06-05-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Background: The effect of different modalities of anaesthesia in microvascular free flap surgery has been a topic of ongoing debate. Comparative data to study the effect of general anaesthesia and regional anaesthesia in the form of peripheral nerve blocks (PNBs) on lower extremity free flap survival is lacking to date. This study aims to elucidate the effect of regional anaesthesia on flap survival in lower extremity free flap reconstructions. Methods: A retrospective cohort study of all patients who underwent free vascularised flap reconstruction of the lower extremities between 2012 and 2021 at the Amsterdam University Medical Centre (UMC), The Netherlands, and between 2019 and 2021 at the Radboud UMC, Nijmegen, The Netherlands. In this cohort, we analysed partial and total flap failures. Results: In this cohort, 87 patients received a total of 102 microvascular free flap reconstructions of the lower extremity. In 20.5% of these operations, patients received a supplemental PNB. Total flap failure was 23.8% in the regional anaesthesia group compared to 21% in the group with general anaesthesia only (p = 0.779). Operation time was longer for patients with regional anaesthesia (p = 0.057). Length of stay was on average 2 days shorter for patients with supplemental regional anaesthesia (p = 0.716). Discussion: This is the largest cohort comparing flap survival in patients receiving general anaesthesia to general anaesthesia with a PNB in lower extremity reconstructions to date. We cannot attribute a significant beneficial or detrimental effect of regional anaesthesia to flap survival. High failure rates stress the need for future studies.

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