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A896
October 16, 2006 9:00 AM - 11:00 AM Room Hall E, Area E |
| Regional Anesthesia for Head and Neck Oncologic and Reconstructive Surgery in High-Risk Patients |
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P. De Negri, M.D., T. Tirri, M.D., G. Paternoster, M.D., P. Modano, M.D., T. Fabrizio, M.D. Anesthesia, Plastic and Reconstructive Surgery, Crob Cancer Center, Rionero, Italy |
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Introduction: Regional techniques are particularly indicated in subjects at high risk like old patients, with respiratory, cardiac or renal disease. Moreover these blocks have a dominating place in ambulatory surgery, allowing a remarkable postoperative analgesia and so facilitating a rapid return to social life. Aim of this study was to evaluate the use of regional anesthetic techniques within the framework of the oncologic and reconstructive surgery of head and neck (removal of cancer lesions and reconstructive surgery). Methods: Between Sep 2004 and Sep 2005, after IRB approval and informed consent, 35 inpatients (18 female, 17 male), mean age 77 yo (range 68 - 95 yr), ASA 3 - 4 were enrolled in our study; cancer lesions (basocellular and spinocellular tumors) were localized in the forehead, nose, face and neck. Surgical procedures after removal of lesions were: direct suture (n 5), random flap (n 7) and pedicoled arterialised flap (n 23). Depending on the area interested by surgical procedure, patients underwent one or more blocks: supraorbital, supratrochlear, infratrochlear or infraorbital nerve block, maxillary nerve block, auriculotemporal nerve plus great auricular nerve and the lesser occipital nerve block by direct injection or by ENS where indicated (eventually bilaterally) with appropriate amount of levobupivacaine 0.5% plus clonidine. All patients underwent conscious sedation with propofol in order to reduce discomfort due to position or lenght of surgical procedure. We analyzed: failure to obtain adequate sensory loss 15 min after anesthetic block, pain during surgery and 24 hrs after on a simple verbal scale of 0 to 10, patient satisfaction on a four point scale and side effects. Results: No surgical procedure requested additional anesthesia as the above techniques offered an excellent analgesia during and after surgery. All patients resulted satisfied regarding the anesthetic technique used. Nor toxic complication due to fast resorption of local anesthetic used, neither nerve damage (due to accurate technique avoiding foramen entrance) have been reported; no PONV or cardio respiratory events were observed.Conclusions: On the basis of the positive 1 year of experience, we strongly believe that the above regional anesthesia techniques, applied in high risk patients, offer significant advantages, both in efficacy and prolonged duration of analgesia, while reducing the risk for adverse side effects due to general anesthesia . References 1.Eaton JS, Grekin RC. Regional anesthesia of the face.Dermatol Surg 2001;27:1006-1009.[figure1][figure2] Anesthesiology 2006; 105: A896 |
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