title: Surgeon-administered, intra-operative transversus abdominis plane block in autologous breast reconstruction: a UK hospital experience.
abstract: OBJECTIVE
  Perioperative Transversus abdominis plane (TAP) block has been well described in the literature as part of the multi-modal approach for management of postoperative pain in gynaecological and general surgery. The senior author started performing ultrasound-guided TAP block perioperatively in DIEP patients in January 2011. The role of surgeon-administered, intra-operative TAP block in abdominal based breast reconstruction surgery was investigated in terms of its efficacy, safety, ease of administration and impact on opioid-related usage and side effects profile.
  
  
  METHODS
  Retrospective analysis of a single surgeon's experience of patients undergoing autologous breast reconstruction using abdominally-based free flaps who received intra-operative, surgeon-delivered TAP block (n=12) compared with a similar patient set not receiving TAP block (n=15). Data was analysed using Student's t-test and assessed for significance of results using p<0.05 as the threshold of significance.
  
  
  RESULTS
  Patient's receiving TAP block had a significantly shorter length of stay (4.75 vs 7.00 days, p=0.002), lower usage of morphine (15.4 vs 71.4 mg, p=0.005), and fewer episodes of peri-operative nausea and vomiting (1 vs 6, p=0.03).
  
  
  CONCLUSIONS
  Perioperative ultrasound guided TAP Block is an effective, cost effective and safe technique for postoperative pain management in abdominal based breast reconstruction.
authors.affiliation: Mountbatten Department of Plastic & Reconstructive Surgery, Queen Alexandra Hospital, Portsmouth PO6 3LY, UK. Electronic address: george.wheble@porthosp.nhs.uk.
authors.forename: George A C
authors.initials: GA
authors.lastname: Wheble
authors.forename: Eric K H
authors.initials: EK
authors.lastname: Tan
authors.forename: Matthew
authors.initials: M
authors.lastname: Turner
authors.forename: Charles A T
authors.initials: CA
authors.lastname: Durrant
authors.forename: Simon
authors.initials: S
authors.lastname: Heppell
mesh_terms: D005260:Female; D058752:Free Tissue Flaps; D006801:Humans; D007902:Length of Stay; D016462:Mammaplasty; D009407:Nerve Block; D010149:Postoperative Pain / Q000517:prevention & control*; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D012189:Retrospective Studies; D006113:United Kingdom
keywords: Analgesia; Autologous breast reconstruction; Intra-operative; TAP block