Postoperative Morphine Requirements of Free TRAM and DIEP Flaps

Abstract

In a review of the charts of 158 patients who had undergone breast reconstruction with free transverse rectus abdominis musculocutaneous (TRAM) or deep inferior epigastric perforator (DIEP) flaps and who were treated for postoperative pain with morphine administered by a patient-controlled analgesia pump, the total dose of morphine administered during hospitalization for the flap transfer was measured. Patients whose treatment was supplemented by other intravenous narcotics were excluded from the study. The mean amount of morphine per kilogram required by patients who had reconstruction with DIEP flaps (0.74 mg/kg, n = 26) was found to be significantly less than the amount required by patients who had reconstruction with TRAM flaps (1.65 mg/kg; n = 132; p < 0.001). DIEP flap patients also remained in the hospital less time (mean, 4.73 days) than did free TRAM flap patients (mean, 5.21 days; p = 0.026), but the difference was less than one full hospital day. It was concluded that the use of the DIEP flap does reduce the patient requirement for postoperative pain medication and therefore presumably reduces postoperative pain. It may also slightly shorten hospital stay.

A Comparison of Perioperative Blood Transfusions and Other Complications Following Transverse Rectus Abdominis Myocutaneous Flaps versus Deep Inferior Epigastric Perforator Flaps

“…Research comparing the two approaches seems to indicate that each method has its strengths and weaknesses. More specifically TRAM flaps have been associated with more abdominal hernias and fat necrosis [7], longer hospital stays and worse postoperative pain [8], whilst DIEP flaps have been reported to have higher numbers of flap losses [9]. Despite an adequate level of research comparing most complication rates there has been a relative paucity of attention given to comparing perioperative transfusion rates between these two reconstructions.…”

Breast Reconstruction with DIEP and S/IGAP

“…Postoperative pain is significantly less with the DIEP flap than with a TRAM flap reconstruction and so it is managed with oral pain medications beginning on postoperative day 1. 13 The patient's urinary catheter, IV, BP cuff, and oxygen are discontinued on day 1 and the patient begins to ambulate. She is discharged home on postoperative day 3 or 4 depending on her recovery.…”

Breast reconstruction using perforator flaps

“…Previously, a TRAM flap could be used to perfuse reliably the abdominal skin and fat at the expense of sacrificing the abdominal rectus muscle and fascia. The DIEP flap can perfuse the same tissue without the sacrificing the rectus muscle or fascia, thereby minimizing donor-site morbidity, pain, and recovery time [2][3][4].…”