Cervical Epidural Anesthesia and Surgical Blood Loss in Radical Mastectomy

To determine whether epidural anesthesia reduces intraoperative blood loss, intraoperative blood loss during radical mastectomy in three groups of patients was compared: cervical epidural plus 67% N2O and O2 (n = 22); enflurane and 67% N2O and O2 (n = 21); and deep enflurane and 67% N2O and O2 (n = 15). Intraoperative blood loss was significantly reduced in the epidural anesthesia group (401 ± 167 ml; mean ± 1 SD) as compared with the normotensive-enflurane group (644 ± 234 ml) and the mild hypotensive-enflurane group (615 ± 218 ml) (p < 0.05). The number of patients given blood transfusion during surgery were 1 of 22 patients in the epidural group, 6 of 21 patients in the nomotensive-enflurane group, and 2 of 15 patients in the mild hypotensive-enflurane group. The duration of surgery and anesthesia did not differ significantly among the three groups. However, the awakening time was significantly shorter in the epidural group compared with both enflurane groups (p < 0.05). The beneficial effects of epidural anesthesia have been reported in total hip replacement and are thought to be due to a decrease in arterial blood pressure. The results of the current study indicate that the mild reduction of arterial blood pressure is unlikely to be responsible for the significant reduction of surgical blood loss associated with cervical epidural block. The application of cervical epdiural anesthesia for radical mastectomy is a safe practice and could provide a reduction of surgical blood loss.