Transversus Abdominis Plane Blocks in Microsurgical Breast Reconstruction: A Systematic Review and Meta-analysis

Abstract

Background Transversus abdominis plane (TAP) blocks have been shown to significantly reduce pain and narcotic consumption following major abdominal surgeries. This study investigates the literature on their use in microsurgical breast reconstruction. Patients and Methods A systematic review of TAP blocks in autologous breast reconstruction was performed. Results Across 10 included studies, 174 patients (5 studies) received an intraoperative TAP block injection, 185 patients (4 studies) received a TAP catheter for intermittent postoperative analgesia, and 325 patients served as controls for a total of 684 included patients. The majority of TAP block delivery techniques were ultrasound guided (7/10 studies). Liposomal bupivacaine (LB) was the most commonly used analgesic (4 studies and139 patients) followed by conventional bupivacaine (3 studies and 105 patients). Eight studies found a significant reduction in oral, intravenous, and/or total morphine requirements in the TAP group when either the daily average and/or total inpatient consumption was compared with the control. Hospital length of stay was significantly shorter for patients undergoing single intraoperative TAP block injection with any analgesic as compared with standard narcotic-based protocols (mean difference= −0.95 days; 95% CI: −1.72 to −0.17 days; p = 0.02). Looking at TAP blocks specifically with LB, there was a mean decrease of 0.83 days as compared with the control, which was not statistically significant (95% CI: −1.90 to 0.25 days; p = 0.13). Conclusion While the current data support the use of TAP blocks in autologous breast reconstruction, additional studies with more standardized protocols should be performed to determine the most optimal practice.

Nerve Blocks in Breast Plastic Surgery: Outcomes, Complications, and Comparative Efficacy

“…Time to perform transversus abdominus plane blocks is minimal, having been reported to range between 5 and 24 minutes and causing no significant delays. 22–24 Greater analgesic benefits were observed in unilateral immediate reconstruction relative to delayed unilateral or bilateral reconstructions and in patients with body mass indexes of more than 25 kg/m 2 . 25,26 Of note, the majority of flaps assessed in the present analysis were muscle-sparing, including deep inferior epigastric perforator, superficial inferior epigastric artery, and muscle-sparing transverse rectus abdominus myocutaneous flaps.…”

“…Both this study and previous meta-analyses demonstrate significant reductions in postoperative pain, opioid consumption, and duration of hospitalization associated with transversus abdominus plane block use. 11,22 The majority of transversus abdominus plane blocks were performed by plastic surgeons under ultrasound guidance, with no complications observed. Time to perform transversus 8e Plastic and Reconstructive Surgery • July 2022 abdominus plane blocks is minimal, having been reported to range between 5 and 24 minutes and causing no significant delays.…”

Transversus abdominus plane blocks do not reduce rates of postoperative prolonged opioid use following abdominally based autologous breast reconstruction: a nationwide longitudinal analysis

“…We found that TAP blocks did not have an appreciable effect on either postoperative narcotic prescriptions or conversion to prolonged opioid use. A systemic review by Abdou et al of single-center studies on patients undergoing abdominally based microsurgical breast reconstruction indicated a statistically significant reduction in total opioid consumption with the use of a TAP block in the inpatient setting; however, other studies have indicated no significant reduction [ 17 , 20 ]. Moreover, there is scarce data in the literature on the long-term impact of TAP blocks on opioid use.…”

Factors influencing postoperative abdominal pain in DIEP flap breast reconstruction

“…In a study of patients undergoing DIEP flap breast reconstruction, a bupivacaine TAP blockade was associated with significantly reduced narcotic consumption compared with infusion pump anesthetic administration and local anesthetic injection (11). Recently, liposomal bupivacaine, which has a long duration of effect, has been widely used in TAP blocks (12). The TAP block technique using liposomal bupivacaine has also been reported to reduce the length of hospital stay after surgery and costs associated with postoperative management after breast reconstruction surgery (8).…”