Efficacy of ultrasound-guided transversus abdominis plane block in breast reconstruction surgery with abdominal myocutaneous flap

Background: Ultrasound (US)-guided transversus abdominis plane block (TAPB) provides postoperative analgesic efficacy in abdominal surgery, however evidence of its efficacy in reconstructive breast surgery with transversus rectus abdominis myocutaneous (TRAM) flap is still limited. Our main objective was to assess effectiveness of TAPB in this surgery.

Methods: Observational retrospective study conducted in patients undergoing unilateral breast reconstruction with TRAM (surgery 1) and mastectomy (partial or total) followed by TRAM reconstruction (surgery 2) from April 2015 to June 2017. Two anaesthetic plans were analysed: general balanced anaesthesia (GBA) and combined GBA with bilateral TAPB (GBA+TAPB). Primary outcomes were total intraoperative administered fentanyl, total consumed morphine in postoperative anaesthesia care unit (PACU) and time between conclusion of surgery and first requested analgesic (analgesia time).

Results: 107 patients were included: 80 submitted to surgery 1 and 27 submitted to surgery 2. In surgery 1, intraoperative fentanyl consumption and administered morphine, during the patients’ stay at PACU, were lower in GBA+TAPB than in GBA group (p<0.001). A longer analgesia time was identified in GBA+TAPB group (p=0.026). Considering surgery 1, at admission at PACU, GBA+TAPB referred lower pain intensity at rest (p=0.049) and on movement (p=0.001), as well as at the 4th postoperative hour, at rest (p=0.005) and on movement (p=0.011). Modified Aldrete scores were higher in GBA+TAPB group (p=0.009).

Regarding surgery 2, globally no significant differences were identified between both groups.

No complications associated to local anaesthetics or TAPB were registered.