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Evaluation of the effect of epidural analgesia on flap healing after breast reconstruction with a pedicled Transverse Rectus Abdominis Muscle (TRAM): A matched pair analysis

par Ben Aziz, Mohammed ;Khalifé, Maher ;Sosnowski, Maurice ;Urbain, Frédéric ;Aoun, Fouad
Référence Research (Lambertville, N.J.), 1, 971
Publication Publié, 2014-07-23

Article révisé par les pairs

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Résumé :

Background: Pain control after breast reconstruction with pedicled TRAM often requires intravenous narcotic analgesia and inpatient hospitalization. Epidural analgesia is increasing in popularity because it decreases the use of intravenous analgesic medications and offer comparable pain relief without the systemic side effects. Purpose: To evaluate the effect of epidural analgesia on postoperative morbidity of pedicle TRAM and compare it with intravenous narcotic analgesia. Methods: 80 patients underwent immediate or delayed pedicled TRAM reconstruction after mastectomy, by the same surgeon, at Jules Bordet Institute. Patients receiving an epidural analgesia were matched 1:3 with patients undergoing intravenous narcotic analgesia for pain control in the same years by the same surgeon. Differences in peri- and postoperative complications across the two groups were assessed using the chi squared test. Cox regression models were constructed to assess differences in flap healing between the two groups. All of the tests were two-sided and performed with a 5% alpha risk. Results: Epidural analgesia was significantly associated with less frequent partial flap necrosis (p<0.05). Regarding more serious postoperative complications, no difference was found across the two cohorts. No statistically significant differences in the length of hospital stay (LOS) were noted. LOS was prolonged in the case of respiratory complications (p=0.026) and wound problem (p<0.0001). On univariate analysis, epidural analgesia, BMI > 25 kg/m2 and Hb level <9 were independently associated with flap necrosis. Conclusion: We found that epidural analgesia was associated with less flap necrosis than intravenous narcotic analgesia. Nonetheless, these results must be confirmed in large prospective multi-institutional studies.