Surgeon-administered, intra-operative transversus abdominis plane block in autologous breast reconstruction: a UK hospital experience

Abstract

Aim: 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).

Conclusion: Perioperative ultrasound guided TAP Block is an effective, cost effective and safe technique for postoperative pain management in abdominal based breast reconstruction.

Keywords: Analgesia; Autologous breast reconstruction; Intra-operative; TAP block.