Abstract: Objective： To compare the efficacy and safety between combined epidural/general anesthesia and general anesthesia in free flap breast reconstruction. Methods： The data of patients, who underwent free flap breast reconstruction under combined epidural/general anesthesia (EA/GA group, n=55) or general anesthesia (GA group, n=60), were collected. The postoperative complications, pain assessment with visual analogue scale (VAS), and incidence of postoperative nausea and vomiting (PONV) were retrospectively analyzed. Results： The incidence of flap thrombosis was 3.6% in the EA/GA group while it was 3.3% in the GA group (P=1.000). And the incidence of flap failure was 0% in the EA/GA group, while it was 3.3% in the GA group (P=0.497). Compared with that in the GA group, patients in the EA/GA group experienced lower VAS scores at 2 h (0.75±0.62 vs 2.31±1.04, P< 0.001), 6 h (1.90±1.18 vs 3.68±1.50, P< 0.001) and 24 h (0.71±0.70 vs 1.34±0.99, P=0.001) postoperatively. Furthermore, the incidence of PONV in the EA/GA group was significantly lower than that in the GA group (P< 0.05). Conclusions： Combined epidural/general anesthesia can relieve postoperative pain and PONV without affecting flap survival in patients undergoing free flap breast reconstruction.