Transversus Abdominis Plane Blocks with Single-Dose Liposomal Bupivacaine in Conjunction with a Nonnarcotic Pain Regimen Help Reduce Length of Stay following Abdominally Based Microsurgical Breast Reconstruction

Jablonka, Eric M.; Lamelas, Andreas M.; Kim, Julie N.; Molina, Bianca J.; Molina, Nathan; Okwali, Michelle; Samson, William; Sultan, Mark R.; Dayan, Joseph H.; Smith, Mark L.

doi:10.1097/prs.0000000000003508

Cited by 57 publications

(80 citation statements)

References 49 publications

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“…Adequate postoperative analgesia is, furthermore, reflected by a mean LOS of 3.5 days in our patient cohort, which compares favorably with other reports following successful implementation of ERAS protocols . Of note, a recent study by Jablonka et al reported an even shorter LOS following introduction of TAP blocks with liposomal bupivacaine, namely an average of 2.65 days …”

Section: Discussionsupporting

confidence: 85%

“…One commonly cited criticism of the latter study is the fact that the ERAS cohort had significantly more DIEP vs. TRAM patients, which was believed to confound the data. 20 In light of the fact, that TRAM flaps have been previously reported to be associated with an increased postoperative morphine requirement, 34 In addition to the small percentage of patients requiring postoperative PCA and the lower total postoperative OME use when compared to our previous report, 6 median patient-reported pain scores were lower in the present study, thus, indicating improved postoperative analgesia, not just based on objective (ie, OME) but also subjective data. Adequate postoperative analgesia is, furthermore, reflected by a mean LOS of 3.5 days in our patient cohort, which compares favorably with other reports following successful implementation of ERAS protocols.…”

Section: Discussionsupporting

confidence: 49%

“…Furthermore, these results compare favorably with the data presented by Batdorf et al, who reported an OME of 167.3 mg in their ERAS cohort. One commonly cited criticism of the latter study is the fact that the ERAS cohort had significantly more DIEP vs. TRAM patients, which was believed to confound the data . In light of the fact, that TRAM flaps have been previously reported to be associated with an increased postoperative morphine requirement, the observations made in this study, in which the majority of patients underwent reconstruction with free MS‐2 TRAM flaps, are particularly encouraging and speak to the beneficial effects of liposomal bupivacaine on postoperative analgesia.…”

Section: Discussionmentioning

confidence: 71%

“…Beneficial effects of ERAS protocols following plastic surgery procedures have been observed as well . The combination of superior postoperative outcomes and decreased length of stay, and thus, decreased health care cost, is particularly appealing and has resulted in implementation of ERAS protocols as an increasingly common quality improvement initiative at various medical centers …”

Section: Introductionmentioning

confidence: 99%

“…18,19 The combination of superior postoperative outcomes and decreased length of stay, and thus, decreased health care cost, is particularly appealing and has resulted in implementation of ERAS protocols as an increasingly common quality improvement initiative at various medical centers. 19,20 The importance of adequate postoperative pain control is reflected in the observation that the immediate effects of inadequate control of acute postoperative pain results in prolonged hospitalization with the long-term risk being the development of chronic pain. 21 Postoperative pain management following autologous breast reconstruction has traditionally relied on opioids.…”

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confidence: 99%

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

et al. 2019

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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.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionsupporting

confidence: 49%

Section: Discussionmentioning

confidence: 71%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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

et al. 2019

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Interventions for reducing the use of opioids in breast reconstruction

Siotos

Cheah

Karahalios

et al. 2020

Cochrane Database of Systematic Reviews

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Data extraction and managementTwo review authors (CS, MAC) will develop a standard data extraction form and independently extract data from the included studies. A third review author (GDR) will resolve any disagreements regarding data collection and extraction. We will collect information on study design, participants, setting, interventions, outcomes, follow-up, methods employed to control for confounders and biases, sources of funding, and notable conflicts of interest of trial authors, amongst other items. For observational studies where we extract adjusted estimates, we will select the most fully adjusted model. Should we identify multiple papers that report results from the same study during the data extraction process, we will select a single paper as the primary Interventions for reducing the use of opioids in breast reconstruction (Protocol)

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