PDF icon Download PDF
J Reconstr Microsurg
DOI: 10.1055/a-2671-4007
Original Article

Abdominal Peripheral Nerve Blocks Do Not Impact Postoperative Pain in Free Flap Breast Reconstruction

Zain Aryanpour 
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
,
Ansley Wallace
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
,
Julian Winocour
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
,
David W. Mathes
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
,
Christodoulos Kaoutzanis
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
,
Katie G. Egan 
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
› Author Affiliations
› Further Information
Also available atMedOne
   Permissions and Reprints
Preview

Abstract

Background

Transverse abdominis plane (TAP) and rectus sheath (RS) blocks are utilized in enhanced recovery after surgery protocols, but with highly variable methodologies and outcomes in reported literature. The purpose of this study was to evaluate the efficacy of abdominal peripheral nerve blocks in free flap breast reconstruction as they pertain to postoperative pain medication requirements and hospital length of stay (LOS).

Methods

Retrospective review was conducted on patients undergoing breast reconstruction with deep inferior epigastric artery perforator free flaps at a large academic institution. Target variables included history of chronic pain diagnosis, laterality, and nerve block type (TAP or RS). Outcomes included daily and total opioid oral morphine milligram equivalents on postoperative days one to three. Patient cohorts were analyzed by TAP block, RS block, or no block. Blocks were performed intraoperatively by the surgical team.

Results

Between 2021 and 2023, 225 patients met the inclusion criteria; 87 received TAP blocks, 72 received RS blocks, and 66 received no block. Patients with chronic pain diagnoses who underwent bilateral reconstruction had higher total postoperative opioid requirements. There were no significant differences in hospital LOS or postoperative pain medication requirements between the three groups before or after controlling for multiple co-variables.

Conclusion

In this large cohort of abdominal-based free flap breast reconstruction patients, there was no impact of peripheral nerve block or nerve block type on postoperative pain medication requirement or hospital LOS. Bilateral flap reconstruction and a history of chronic pain diagnoses were the only factors found to affect perioperative opioid utilization in patients undergoing abdominally based breast reconstruction.

Keywords

tap block - nerve block breast reconstruction - ERAS

Presented at: this project was accepted as a podium presentation to the American Society of Reconstructive Microsurgery's Annual Meeting in January 2025.




Publication History

Received: 30 January 2025

Accepted: 26 July 2025

Article published online:
14 August 2025

© 2025. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA