Transversus Abdominis Plane Block and Free Flap Abdominal Tissue Breast Reconstruction: Is There a True Reduction in Postoperative Narcotic Use?

Cedric Hunter, Afaaf Shakir, Arash Momeni, Anna Luan, Lauren Steffel, Jean Louis Horn, Dung Nguyen, Gordon K. Lee

Research output: Contribution to journalArticle

Abstract

Introduction The use of the transversus abdominis plane (TAP) block is increasing in abdominally based autologous tissue breast reconstruction as a method to provide postoperative donor site analgesia. The purpose of this study was to evaluate the efficacy of the TAP block in the immediate postoperative period. Methods A retrospective analysis of all patients who underwent autologous microsurgical breast reconstruction over a 2-year period (2013-2015) was conducted. Only patients with an abdominal donor site were included. Patients were grouped based on the presence or absence of TAP blocks. Primary endpoints included patient-reported pain score, daily and total narcotic use during the hospitalization, antiemetic use, as well as complications. Results We identified 40 patients that had undergone abdominal-based free flap breast reconstruction and TAP block catheter placement for postoperative analgesia that met inclusion criteria. This group was then compared with a matched cohort of 40 patients without TAP blocks. There were no complications associated with using the TAP catheters. There was no statistically significant difference in postoperative pain scores, daily or total narcotic use during the hospitalization, or antiemetic use between the 2 groups. Although not statistically significant, linear regression analysis identified trends of improved donor site analgesia in select groups, such as unilateral immediate reconstructions, body mass index greater than 30 kg/m2, and those without abdominal mesh placed at the time of donor site closure in the TAP block group. Conclusions Constant delivery of local anesthetic through the TAP block appears to be safe; however, it did not reduce narcotic requirements or postoperative pain scores in patients undergoing abdominal-based free flap breast reconstruction.

Original languageEnglish (US)
Pages (from-to)254-259
Number of pages6
JournalAnnals of plastic surgery
Volume78
Issue number3
DOIs
StatePublished - Mar 1 2017
Externally publishedYes

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Abdominal Muscles
Mammaplasty
Free Tissue Flaps
Narcotics
Tissue Donors
Analgesia
Antiemetics
Postoperative Pain
Hospitalization
Catheters
Local Anesthetics
Postoperative Period
Linear Models
Body Mass Index
Regression Analysis
Pain

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Transversus Abdominis Plane Block and Free Flap Abdominal Tissue Breast Reconstruction : Is There a True Reduction in Postoperative Narcotic Use? / Hunter, Cedric; Shakir, Afaaf; Momeni, Arash; Luan, Anna; Steffel, Lauren; Horn, Jean Louis; Nguyen, Dung; Lee, Gordon K.

In: Annals of plastic surgery, Vol. 78, No. 3, 01.03.2017, p. 254-259.

Research output: Contribution to journalArticle

Hunter, Cedric ; Shakir, Afaaf ; Momeni, Arash ; Luan, Anna ; Steffel, Lauren ; Horn, Jean Louis ; Nguyen, Dung ; Lee, Gordon K. / Transversus Abdominis Plane Block and Free Flap Abdominal Tissue Breast Reconstruction : Is There a True Reduction in Postoperative Narcotic Use?. In: Annals of plastic surgery. 2017 ; Vol. 78, No. 3. pp. 254-259.
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abstract = "Introduction The use of the transversus abdominis plane (TAP) block is increasing in abdominally based autologous tissue breast reconstruction as a method to provide postoperative donor site analgesia. The purpose of this study was to evaluate the efficacy of the TAP block in the immediate postoperative period. Methods A retrospective analysis of all patients who underwent autologous microsurgical breast reconstruction over a 2-year period (2013-2015) was conducted. Only patients with an abdominal donor site were included. Patients were grouped based on the presence or absence of TAP blocks. Primary endpoints included patient-reported pain score, daily and total narcotic use during the hospitalization, antiemetic use, as well as complications. Results We identified 40 patients that had undergone abdominal-based free flap breast reconstruction and TAP block catheter placement for postoperative analgesia that met inclusion criteria. This group was then compared with a matched cohort of 40 patients without TAP blocks. There were no complications associated with using the TAP catheters. There was no statistically significant difference in postoperative pain scores, daily or total narcotic use during the hospitalization, or antiemetic use between the 2 groups. Although not statistically significant, linear regression analysis identified trends of improved donor site analgesia in select groups, such as unilateral immediate reconstructions, body mass index greater than 30 kg/m2, and those without abdominal mesh placed at the time of donor site closure in the TAP block group. Conclusions Constant delivery of local anesthetic through the TAP block appears to be safe; however, it did not reduce narcotic requirements or postoperative pain scores in patients undergoing abdominal-based free flap breast reconstruction.",
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