Transversus abdominis plane block following abdominally based breast reconstruction: study protocol for a randomized...

Area of Science:

• Oncology
• Plastic Surgery
• Pain Management

Background:

• Free muscle-sparing transversus abdominus myocutaneous (TRAM) or deep inferior epigastric perforator (DIEP) flaps are common for breast reconstruction.
• Abdominal donor site pain is a significant issue, often managed with intravenous opioids and their side effects.
• The transversus abdominis plane (TAP) block is a novel approach for managing incisional pain.

Purpose of the Study:

• To assess the effectiveness of a TAP block with local anesthetic in reducing postoperative abdominal pain.
• To compare total opioid consumption in the first 48 hours post-surgery between TAP block and control groups.
• To evaluate secondary outcomes including pain scores, nausea, sedation, and recovery metrics.

Main Methods:

• A double-blind, placebo-controlled, randomized trial was conducted.
• Participants received either a TAP block with local anesthetic or a placebo.
• Opioid consumption (patient-controlled anesthesia and oral doses) was converted to morphine equivalent units for comparison.

Main Results:

• The study aimed to compare mean total opioid consumption in the first postoperative 48 hours.
• Secondary outcomes included in-hospital opioid use, pain scores, anti-nausea consumption, nausea and sedation levels, Quality of Recovery scores, and time to bowel movement and ambulation.

Conclusions:

• Autologous breast reconstruction using abdominal tissue is increasingly preferred for postmastectomy patients.
• Abdominal wall incision pain is a major contributor to discomfort after these procedures.
• The TAP block shows potential to decrease reliance on systemic opioids and improve patient outcomes in breast cancer surgery.