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J Reconstr Microsurg
DOI: 10.1055/a-2671-7296
Original Article

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

Authors

  • Rachel H. Park

    1   Department of Plastic Surgery, Maxillofacial and Oral Health, University of Virginia Health System, Charlottesville, Virginia, United States

  • Ugochukwu K. Odega

    2   University of Virginia School of Medicine, Charlottesville, Virginia, United States

  • Robert G. DeVito

    1   Department of Plastic Surgery, Maxillofacial and Oral Health, University of Virginia Health System, Charlottesville, Virginia, United States

  • Jesse Chou

    1   Department of Plastic Surgery, Maxillofacial and Oral Health, University of Virginia Health System, Charlottesville, Virginia, United States

  • Chris A. Campbell

    1   Department of Plastic Surgery, Maxillofacial and Oral Health, University of Virginia Health System, Charlottesville, Virginia, United States

  • John T. Stranix

    1   Department of Plastic Surgery, Maxillofacial and Oral Health, University of Virginia Health System, Charlottesville, Virginia, United States
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Abstract

Background

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

Methods

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.

Results

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).

Conclusion

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

Keywords

breast reconstruction - free flap - regional block

Note

This study was presented at the 2024 ASRM as a podium presentation.




Publication History

Received: 16 January 2025

Accepted: 25 July 2025

Accepted Manuscript online:
31 July 2025

Article published online:
22 August 2025

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