REGIONAL ANESTHESIA FOR MICROVASCULAR SURGERY - A COMBINATION OF BRACHIAL-PLEXUS, SPINAL, AND EPIDURAL BLOCKS

Background and Objectives. To evaluate the usefulness, safety, and eff icacy of the combined plexus brachial, spinal, and epidural blocks in free toe to hand transplantations. Methods. Design: Prospective, case series. Setting: Tampere University Hospital, Finland. Patients: Fifte en adult patients for toe to hand microvascular transplantation under combined regional anesthesia with bupivacaine. Interventions: The effi cacy of the blocks, complications, and patient satisfaction were recor ded in the study form. Measurements and Main Results. The duration of operations varied between 8 and 18 hours. No major complications occur red. Vasodilatation in the operated hand was maintained during the ent ire operation as well as in the postoperative period, and the surgical results were satisfactory. The mean skin temperature was 5-degrees-C higher in the blocked extremity compared to the opposite hand. In ever y patient the skin temperature of the transplant was over 32.4-degrees -C after the operation. Blood pressure, heart rate, temperature and ox ygen saturation were well maintained during the entire procedure. All patients were satisfied with their anesthesia. Back pain occurred in 1 1 patients and in two it was considered severe. One patient may have h ad a systemic toxic reaction (shivering) due to high plasma levels of bupivacaine, but the symptom was transient. Conclusion. Combined regio nal anesthesia is an alternative to general anesthesia in prolonged mi crosurgical operations and it appears to improve perfusion of the tran splanted extremity.