Abdominoplasty Under Epidural Anesthesia: Safer for the Patient, Easier for the Surgeon

Background:  Abdominoplasty is one of the most popular body-contouring procedures.  It is a major operation, commonly performed under general anesthesia, and is associated with a high rate of minor complications, such as seroma, wound dehiscence, infection, nerve damage and skin necrosis, and also some major life-threatening complication including myocardial infarction, cerebrovascular accident, deep vein thrombosis and pulmonary embolism.

Methods:  131 abdominoplasties were performed under high (T12-L1) epidural anesthesia using  10 ml Ropivacaine 0.6% (Naropin) since January 2011 to February 2014   This method provides sensory anesthesia without muscle paralysis.  Lengths of operation, recovery and hospitalization were evaluated, as well as complications rates.

Results:  Complications were extremely rare- one patient had postoperative bleeding and two had partial umbilical necrosis.  Other parameters were comparable to those in the literature.  All patients were able to move during the operation according to the surgeon's instructions.  Patients expressed satisfaction with the operation and there were no complaints regarding the lack of general anesthesia.

Discussion:  Abdominoplasty under epidural anesthesia has many practical advantages:  abdominoplasty is often combined with liposuction and requires several intraoperative positional changes.  A conscious patient, who maintains the ability to cooperate with the surgeon throughout the operation, makes the work of the surgeon easier and more efficient as the patient repositions himself according to the surgeon's instruction.  The transfer to the recovery room is simple and convenient, as the patient is awake. This type of anesthesia seems to reduce the rate of major complications such as DVT, PE, MI and CVA.  In addition, due to the continuing epidural analgesia, the recovery period is shorter, and associated with less pain, nausea and vomiting.

Conclusion: Abdominoplasty under epidural anesthesia proves to be safer for the patient as well as easier for the surgeon.