The Efficacy of Transversus Abdominis Plane Blocks in Abdominal Tissue Free Flap Breast Reconstruction

Regional blocks are effective adjuncts in autologous breast reconstruction. Data on specific regional blocks and agents remain unclear.

We performed a retrospective review of patients who underwent abdominal free flap breast reconstruction between July 2017 and June 2022. A total of 256 patients were included with 181 who received Exparel transversus abdominis plane (TAP) blocks, 54 with non-Exparel TAP blocks, and 21 without a TAP block. Length of stay (LOS), intensive care unit length of stay (ICU LOS), average daily morphine milligram equivalents (MME), and average total MME were collected.

Comparing the Exparel TAP block cohort and non-Exparel TAP block cohort, there was no difference in LOS (2.71 vs. 2.72 days, p = 0.96), ICU LOS (0.35 vs. 0.56 days, p = 0.18), daily MME (29.08 vs. 29.71 MME, p = 0.85), and total MME (113.69 vs. 113.92 MME, p = 0.99). Comparing the Exparel TAP block cohort and non-TAP block cohort, there were significant differences in LOS (2.71 vs. 3.62 days, p = 0.003), ICU LOS (0.35 vs. 1.1 days, p = 0.001), daily MME (29.08 vs. 39.56, p = 0.04), and total MME (113.69 vs. 195.55, p = 0.001). When comparing the non-Exparel TAP block cohort and the non-TAP block cohort, there were differences in LOS (2.72 vs. 3.62 days, p = 0.004), ICU LOS (0.56 vs. 1.1 days, p = 0.04), and total MME (113.92 vs. 195.55 MME, p = 0.006).

TAP block can effectively reduce the LOS and postoperative narcotic use in patients undergoing autologous breast reconstruction regardless of the choice of local anesthetic.