title: Ultrasound-guided bilateral transversus abdominis plane block for postoperative analgesia after breast reconstruction by DIEP flap.
abstract: BACKGROUND
  Autologous breast reconstruction by deep inferior epigastric perforator (DIEP) flap provides higher postoperative pain at the abdominal donor site than at the thoracic one. The authors evaluated the analgesic efficacy of ultrasound-guided transverse abdominis plane block for postoperative analgesia after immediate breast reconstruction by DIEP flap.
  
  
  METHODS
  The authors conducted an open prospective study of 30 consecutive women undergoing immediate DIEP flap breast reconstruction after modified radical mastectomy for cancer. The last 15 patients received a bilateral ultrasound-guided block with 1.5 mg/kg ropivacaine on each side after DIEP flap harvesting, under general anesthesia. All patients received postoperative acetaminophen and patient-controlled intravenous morphine and were assessed for morphine use, satisfaction with pain relief, and adverse effects.
  
  
  RESULTS
  Morphine requirements were significantly lower in the block group than in the control group for the 0- to 12-hour (17.7 mg versus 22.7 mg, p = 0.0047) and 12- to 24-hour (14.2 mg versus 17.4 mg, p = 0.01) intervals but not for the 24- to 36-hour (11.3 mg versus 12.2 mg, p = 0.30) and 36- to 48-hour (8.6 mg versus 8.4 mg, p = 0.65) intervals. Cumulative morphine use was lower in the block group than in the control group for the first 24 hours (32.0 mg versus 40.2 mg, p = 0.0057) and the first 48 hours (51.7 mg versus 60.5 mg, p = 0.03). There was no complication attributable to the block, with an average follow-up of 9 months.
  
  
  CONCLUSIONS
  Bilateral ultrasound-guided transversus abdominis plane block after breast reconstruction by DIEP flap reduces the interval and cumulative morphine requirements for the first 24 and 48 hours, respectively.
  
  
  METHODS
  : Therapeutic, II.(Figure is included in full-text article.).
authors.affiliation: Créteil, France From the Departments of Plastic and Surgery and Anesthesiology and Reanimation, GHU A. Chenevier H. Mondor, Université Paris Est Créteil.
authors.forename: Mikaël
authors.initials: M
authors.lastname: Hivelin
authors.forename: Anne
authors.initials: A
authors.lastname: Wyniecki
authors.forename: Benoit
authors.initials: B
authors.lastname: Plaud
authors.forename: Jean
authors.initials: J
authors.lastname: Marty
authors.forename: Laurent
authors.initials: L
authors.lastname: Lantieri
mesh_terms: D000009:Abdominal Muscles; D000328:Adult; D000368:Aged; D000698:Analgesia / Q000379:methods*; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010149:Postoperative Pain / Q000517:prevention & control*; D011446:Prospective Studies; D013524:Surgical Flaps; D018084:Ultrasonography, Interventional