Abdominally Based Microsurgical Breast Reconstruction: Medical center in New York
Study Methods
- 128 adult patients undergoing breast reconstruction using abdominally based free flaps with or without a non-narcotic protocol using intraoperative TAP blockade. Patients were divided into a control group, a TAP catheter group, and a TAP EXPAREL group
- Retrospective observational study
- Primary and secondary outcomes were assessed for associations and adjusted for confounding variables
Safety Outcomes
- The overall complication rate was 8.7%, with no significant differences between the groups
- The TAP catheter group noted higher rates of transfusions (P=0.0084)
Clinical and Economic Outcomes
In patients who received EXPAREL for analgesia
Fewer total opioids used
after surgery vs catheter and control groups (mg)*†
- Day 0–1: 1.88 vs 7.25 (P=0.0081) vs 52.86 (P<0.0001)
- Day 2: 2.12 vs 5.17 (P=0.0270) vs 29.9 (P=0.0009)
0.9 to
1.4 days
shorter LOS
- EXPAREL group: 2.65 days
- TAP catheter group: 3.52 days
- Control group: 4.05 days
BREAST RECONSTRUCTION WITH TAP EXPAREL (n=40)
- 15 mg of IV ketorolac and 1000 mg of IV acetaminophen at the end of surgery and then every 6 hours postsurgery
- After tolerance of an oral diet, patients switched to an oral regimen of 10 mg of ketorolac and 650 mg of acetaminophen, with oral opioids as needed for breakthrough pain
- A mixture of 20 mL of 1.3% EXPAREL, 30 mL of standard bupivacaine, and 80 mL of normal saline infiltrated at 30 mL into each side
- The remainder of the mixture was infiltrated into the lower abdominal incision, pectoralis major muscle near the anastomotic site, superficial serratus plane, and drain sites
BREAST RECONSTRUCTION WITH TAP CATHETER (n=48)
- 15 mg of IV ketorolac and 1000 mg of IV acetaminophen at the end of surgery and then every 6 hours postsurgery
- After tolerance of an oral diet, patients switched to an oral regimen of 10 mg of ketorolac and 650 mg of acetaminophen, with oral opioids as needed for breakthrough pain
- 30 mL of 0.25% bupivacaine injected bilaterally, followed by transcutaneous passing of bilateral epidural catheters into the plane and connected to a 400-mL capacity fixed-rate pump filled with 0.25% bupivacaine delivered through each catheter at 2 mL per hour
BREAST RECONSTRUCTION WITH NARCOTIC-BASED ANALGESIA CONTROL GROUP (n=40)
- Standard narcotic-based analgesia regimen without locoregional anesthesia
- IV PCA opioid pump with additional nurse-administered opioids for breakthrough pain, followed by transition to an as-needed oral opioid
*Opioid consumption was measured using IV morphine equivalent (mg).
†The clinical benefit of the decrease in opioid consumption was not demonstrated in the clinical trials.
TAP, transversus abdominis plane.