title: Transversus Abdominis Plane Block and Free Flap Abdominal Tissue Breast Reconstruction: Is There a True Reduction in Postoperative Narcotic Use?
abstract: BACKGROUND
  The use of the transversus abdominis plane (TAP) block is increasing in abdominally based autologous tissue breast reconstruction as a method to provide postoperative donor site analgesia. The purpose of this study was to evaluate the efficacy of the TAP block in the immediate postoperative period.
  
  
  METHODS
  A retrospective analysis of all patients who underwent autologous microsurgical breast reconstruction over a 2-year period (2013-2015) was conducted. Only patients with an abdominal donor site were included. Patients were grouped based on the presence or absence of TAP blocks. Primary endpoints included patient-reported pain score, daily and total narcotic use during the hospitalization, antiemetic use, as well as complications.
  
  
  RESULTS
  We identified 40 patients that had undergone abdominal-based free flap breast reconstruction and TAP block catheter placement for postoperative analgesia that met inclusion criteria. This group was then compared with a matched cohort of 40 patients without TAP blocks. There were no complications associated with using the TAP catheters. There was no statistically significant difference in postoperative pain scores, daily or total narcotic use during the hospitalization, or antiemetic use between the 2 groups. Although not statistically significant, linear regression analysis identified trends of improved donor site analgesia in select groups, such as unilateral immediate reconstructions, body mass index greater than 30 kg/m, and those without abdominal mesh placed at the time of donor site closure in the TAP block group.
  
  
  CONCLUSIONS
  Constant delivery of local anesthetic through the TAP block appears to be safe; however, it did not reduce narcotic requirements or postoperative pain scores in patients undergoing abdominal-based free flap breast reconstruction.
authors.affiliation: From the *Division of Plastic Surgery, and †Department of Anesthesia, Stanford University Medical Center, Palo Alto, CA.
authors.forename: Cedric
authors.initials: C
authors.lastname: Hunter
authors.forename: Afaaf
authors.initials: A
authors.lastname: Shakir
authors.forename: Arash
authors.initials: A
authors.lastname: Momeni
authors.forename: Anna
authors.initials: A
authors.lastname: Luan
authors.forename: Lauren
authors.initials: L
authors.lastname: Steffel
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Horn
authors.forename: Dung
authors.initials: D
authors.lastname: Nguyen
authors.forename: Gordon K
authors.initials: GK
authors.lastname: Lee
mesh_terms: D000009:Abdominal Muscles / Q000294:innervation* / Q000601:surgery; D000328:Adult; D000368:Aged; D000577:Amides; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000779:Anesthetics, Local; D005260:Female; D058752:Free Tissue Flaps / Q000637:transplantation*; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000188:drug therapy / Q000517:prevention & control*; D012189:Retrospective Studies; D000077212:Ropivacaine; D016896:Treatment Outcome
chemical_list: D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000077212:Ropivacaine