Description of the double-puncture epidural technique for plastic surgery: a historical cohort

Introduction: The epidural technique has been used for anesthesia during surgical procedures and also as a primary anesthetic or adjuvant for pain management. Objective: To describe the double-puncture epidural technique in plastic surgery. Methods: Observational retrospective study including data from patients who underwent plastic surgery between 2013 and 2022. For the double-puncture epidural technique intervertebral spaces T3-T4 and/or L1-L2 are identified with patients in the sitting position. The solution used for epidural anesthesia (EA) comprised 30mL of levobupivacaine 0.75%, 10mL of 0.5% bupivacaine, and 20mL of normal saline. First, 20mL of the EA are administered into the T3-T4 space, and later, the remaining 40mL are administered into the L1-L2 space. The catheter is secured with sterile micropore, and the patient is prepared for surgery. Descriptive statistics were used to characterize the population. Results: A total of 1963 patients were analyzed, of which 79.89% received double-puncture epidural anesthesia. Just a few patients (2.04%) required additional boluses of EA, 1.85% experienced bradycardia and 3.57% developed hypotension. Using the Bromage motor block scale, 97.03% of the patients had a score between 0 and 1. Only 0.38% of the patients had at least one complication. There was no relationship between the type of anesthesia and the variables including puncture level, booster, hemodynamic stability, pump use, and Bromage. Conclusions: Our results suggest that the double-puncture EA technique is a safe and reliable option, associated with few complications and effective analgesia.