Comparison of surgical complication rate in patients receiving regional and general anaesthesia for microvascular free tissue transfer

Objective: Microvascular flap transfer provides a reliable method to deal with difficult
reconstructions and major defects. It is a complex surgical procedure, and despite advances in
surgical and anaesthetic management, flap failure continues to be a rare yet significant and
devastating complication. There is a multitude of factors that can influence the outcome of
microvascular flap surgery and optimal anaesthetic management is of utmost importance in
the success of flap transposition. There is an ongoing debate about the preferred method of
anaesthesia for flap success. Some evidence suggests that regional anaesthesia might not be
preferred for most types of flap surgery, but more studies are needed to propose clear
recommendations on the preferred type of anaesthesia. We aim to evaluate the differences in
the rate of microvascular flap surgery complications between patients receiving regional and
general anaesthesia.
Materials and Methods: A retrospective cohort study design was selected. The study
includes 51 adult patients who underwent elective microvascular flap surgeries in Latvian
Centre of Reconstructive and Microsurgery. All patients were aged 18 to 65 and had an ASA
score of 3 or less. Anaesthesia method for long lasting reconstructive surgery was chosen
according to individual surgical necessity. Regional anaesthesia was performed with spinal
anaesthesia and brachial plexus block. Induction of general anaesthesia was performed using
propofol (1.5-2 mg/kg), fentanyl (1.5 µg/kg), and cis-atracurium (0.2 mg/kg). Isoflurane
(minimal alveolar concentration 0.5-1) and continuous infusions of fentanyl (2 mcg/kg/h) and
cis-atracurium (0.03 mg/kg/h) were used for maintenance of general anaesthesia. The patients
were divided into two groups – regional anaesthesia (RA) group (N=23) and general
anaesthesia (GA) group (N=28). Postoperative outcome information such as flap
complications, duration of intensive care and total duration of hospitalization was obtained.
Methods of statistical analysis such as Pearson Chi-Square test and Mann-Whitney U test
were performed using IBM SPSS. Results were considered significant if p<0.05.
Results: There were no statistically significant differences in age and sex distribution
between the RA and GA groups. RA and GA groups had no statistically significant
differences in the rate of flap failure, infection, hematoma, or any other type of flap
complication. GA group had a mean intensive care stay duration of 2.32 days (CI 95% 0.64-
5.29). RA group had a significantly lower mean intensive care stay duration of 0.26 days
(0.06-0.58). This difference in intensive care stay duration was statistically significant
(p=0.003). GA group had a mean hospitalization duration of 24.5 days (14.85-34.14). RA
group had a comparatively lower mean hospitalization duration of 14.52 days (9.95-19.08).
This difference in the duration of hospitalization between the groups also was statistically
significant (p=0.042).
Conclusion: The results of this study imply that the rate of surgical complications in
microvascular flap surgery is equal for both regional and general anaesthesia. Moreover,
patients who receive general anaesthesia have a longer mean intensive care stay and duration
of hospitalization. In contrast to previous assertions, a meticulously administered regional
anaesthesia might be the preferred type of anaesthesia for most types of microvascular flap
surgery.