Effect of transversus abdominis plane blocks in abdominoplasties on postoperative outcomes

Abstract

Background: Acute postoperative pain after surgery may lead to significant complications including chronification of pain, impaired cardiopulmonary function, and increased healthcare costs. As a common and complex procedure, abdominoplasty is a key focus for pain management strategies. Although transversus abdominis plane blocks, which target the abdominal wall's sensory nerves to reduce postoperative pain by blocking nociceptive input, have shown promise in reducing postoperative pain in abdominal surgeries, their use in abdominoplasty remains underexplored.

Methods: Outcomes for patients undergoing abdominoplasty between 2013 and 2024 were analysed, comparing those who received a transversus abdominis plane block with those who did not. Postoperative analgesia followed a standardized protocol using oral narcotics and piritramide. Pain outcomes were assessed in both groups via chart review. The primary outcome, length of hospital stay, was analysed by multivariable linear regression adjusted for patient and surgical factors. Secondary outcomes, including complications and revision rates, were assessed by logistic regression. Exploratory analyses examined how reductions in medication use affected length of hospital stay and discharge timing.

Results: Overall, 192 patients who had an abdominoplasty were included in analyses: 93 had a transversus abdominis plane block and 99 did not. The transversus abdominis plane group had a significantly shorter hospital stay, with a reduction of 2.21 (95% confidence interval (c.i.) -3.07 to -1.36) days after adjusting for confounders (P < 0.001; effect size, Cohen's d 0.45). Surgical complications occurred in 46.9% of patients. The overall complication risk in the transversus abdominis plane block group was significantly reduced by 52% (adjusted odds ratio 0.44, 95% c.i. 0.23 to 0.84; P = 0.012; effect size 0.52), particularly the occurrence of haematoma (adjusted odds ratio 0.34; P = 0.031; effect size 0.66). Additionally, patients who had a transversus abdominis plane block required less postoperative medication, including lower tilidine (P = 0.038) and metamizole (P = 0.032) doses.

Conclusion: Use of the transversus abdominis plane block in patients who had an abdominoplasty was associated with improved postoperative outcomes, highlighting its potential as an effective pain management strategy and supporting its broader clinical application.

Fig. 1

Flow chart of patient selection process and exclusion criteria *Lipoabdominoplasties > 250 ml; †other surgeries; ‡missing data; DIEP, deep inferior epigastric perforator; SIEA, superficial inferior epigastric artery; TRAM, transverse rectus abdominis myocutaneous; ASA, American Society of Anesthesiologists; PONV, postoperative nausea and vomiting; TAP, transversus abdominis plane.

Fig. 2

Illustration of injection technique and anatomical landmarks

Fig. 3

Box plot comparing length hospital of stay between patients who received a TAP block and those who did not Median value (bold centre line), interquartile range (box), and range (error bars) excluding outliers (symbols) are shown. TAP, transversus abdominis plane.

Fig. 4

Box plots comparing discharge tilidine and metamizole dosages between patients who received a TAP block and those who did not a Discharge tilidine dosage; b discharge metamizole dosage. Median value (bold centre line), interquartile range (box), and range (error bars) excluding outliers (symbols) are shown. TAP, transversus abdominis plane.