title: Direct Transversus Abdominis Plane Blocks With Exparel During Abdominoplasty.
abstract: BACKGROUND
  Pain control following abdominoplasty is a major source of concern for the patient and surgeon alike. Pain pumps and opiate medications are currently the frontline therapies. With the following technique, Exparel (liposomal bupivacaine, 72-hour duration of action) has been used for transversus abdominis plane (TAP) blocks under direct visualization during abdominoplasty with the goal of improving pain control during the early and intermediate recovery period.
  
  
  METHODS
  In this pilot study, 13 consecutive patients were treated with the direct, fascial-splitting technique to reach the TAP plane. Using a spinal needle, 20 mL of liposomal bupivacaine was injected deep to the internal oblique fascia bilaterally under direct vision. Primary and secondary endpoints of total opiate use and patient reported pain scores were assessed.
  
  
  RESULTS
  All 13 patients met inclusion criteria as abdominoplasty patients with adequate follow-up data. The average visual analog scale pain score was 2.5 on postoperative day 1 and 1.7 on postoperative day 3. The average total opiate use (the number of 10 mg oxycodone tabs consumed) was 7.5 or 75 mg per patient.
  
  
  CONCLUSIONS
  This pilot study demonstrates the safety and efficacy of liposomal bupivacaine TAP blocks under direct vision. Favorable pain control was demonstrated. This represents an exciting opportunity to decrease postoperative pain in the early and intermediate recovery period after abdominoplasty.
authors.affiliation: From the *Plastic & Reconstructive Surgeons, Private Practice, Fiala Aesthetics, Orlando, FL; and †Senior Resident, Department of Radiology, University of Rochester Medical Center, Rochester, NY.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Oppenheimer
authors.forename: Thomas G S
authors.initials: TGS
authors.lastname: Fiala
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Oppenheimer
mesh_terms: D000009:Abdominal Muscles / Q000294:innervation*; D061645:Abdominoplasty; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections; D008081:Liposomes; D009407:Nerve Block / Q000379:methods*; D010149:Postoperative Pain / Q000517:prevention & control*; D010865:Pilot Projects; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D008081:Liposomes; D002045:Bupivacaine