Postoperative analgesia after microsurgical breast reconstruction using liposomal bupivacaine (Exparel)

Conventional opioid-based regimen for postoperative analgesia after autologous breast reconstruction can be associated with significant side effects. The purpose of this study was to assess the efficacy of an intraoperatively administered transversus abdominis plane (TAP) block with liposomal bupivacaine on postoperative narcotic use in patients undergoing microsurgical breast reconstruction with free abdominal flaps. Patients treated between December 2016 and June 2017 were included in the study. Parameters of interest were patient-reported pain score, total narcotic use (in oral morphine equivalent [OME]) during the hospitalization, length of stay (LOS), and the need for patient-controlled analgesia (PCA). Eighty-two free abdominal flaps were transferred in 46 patients with a mean age of 47.6 years and a mean body mass index (BMI) of 28.1 kg/m² . The average LOS was 3.5 days (range, 3-5). Postoperatively, 42 patients (91.3%) did not require patient-controlled analgesia (PCA). The mean time to first narcotic use after arrival on the nursing unit was 6 hours (range, 0-19 hours). The mean total postoperative OME use was 123.2 mg (range, 0-285 mg). However, analysis of OME use excluding the four patients requiring PCA revealed a mean OME use of 90.3 mg (range, 0-167.5 mg). Liposomal bupivacaine provides for reliable, safe, and long-acting postoperative analgesia and contributes to a reduction in postoperative narcotic intake. The use of liposomal bupivacaine shows great promise in improving the standard of care in postoperative analgesia in microsurgical breast reconstruction.