区域麻醉对下肢重建中游离皮瓣存活率的影响

IF 1 Q3 ORTHOPEDICS

Strategies in Trauma and Limb Reconstruction Pub Date : 2024-01-01 DOI:10.5005/jp-journals-10080-1612

Isabelle Ts Koster, Matthijs M den Os, Martin Vh Rutten, Thibault Ri van den Dungen, Tim de Jong, Hay Ah Winters, Caroline Driessen

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引用次数: 0

摘要

背景：微血管游离皮瓣手术中不同麻醉方式的效果一直是一个争论不休的话题。迄今为止，还缺乏研究全身麻醉和周围神经阻滞（PNB）形式的区域麻醉对下肢游离皮瓣存活率影响的比较数据。本研究旨在阐明区域麻醉对下肢游离皮瓣重建术中皮瓣存活率的影响：方法：对2012年至2021年期间在荷兰阿姆斯特丹大学医学中心（UMC）和2019年至2021年期间在荷兰奈梅亨拉德布德大学医学中心（Radboud UMC）接受下肢游离血管化皮瓣重建术的所有患者进行回顾性队列研究。在这个队列中，我们分析了部分和全部皮瓣失败的情况：在这个队列中，87名患者共接受了102次下肢微血管游离皮瓣重建手术。在这些手术中，20.5%的患者接受了PNB补充治疗。区域麻醉组的皮瓣总失败率为23.8%，而仅采用全身麻醉组的失败率为21%（P = 0.779）。采用区域麻醉的患者手术时间更长（p = 0.057）。辅助区域麻醉患者的住院时间平均缩短2天（p = 0.716）：讨论：这是迄今为止在下肢重建手术中比较接受全身麻醉和PNB全身麻醉患者皮瓣存活率的最大规模队列。我们无法确定区域麻醉对皮瓣存活率有明显的有利或不利影响。高失败率强调了未来研究的必要性：Koster ITS, den Os MM, Rutten MVH, et al. 区域麻醉对下肢重建中游离皮瓣存活率的影响。Strategies Trauma Limb Reconstr 2024;19(1):15-20.

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

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.

How to cite this article: Koster ITS, den Os MM, Rutten MVH, et al. The Effect of Regional Anaesthesia on Free Flap Survival in Lower Extremity Reconstructions. Strategies Trauma Limb Reconstr 2024;19(1):15-20.

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来源期刊

Strategies in Trauma and Limb Reconstruction Medicine-Orthopedics and Sports Medicine

CiteScore

1.50

自引率

0.00%

发文量

期刊介绍： Strategies in Trauma and Limb Reconstruction is dedicated to surgeons, allied medical professionals and researchers in the field of orthopaedics and trauma. The scope of the journal is to discuss the fields of skeletal injury, and the complications thereof, congenital and acquired limb deformities and deficiencies, and orthopaedic-related infection, together with their surgical and non-surgical treatments. The journal publishes original articles, reviews, case reports, descriptions of new or recognised treatment techniques, forum discussions of clinical scenarios and relevant correspondence. It aims to provide a widely accessible source of useful information to practitioners in the field through the problem- or technique-based approach of published articles.