by Gatherwright,
James; Knackstedt, Rebecca W.; Ghaznavi, Amir M.; Bernard, Steven; Schwarz,
Graham; Moreira, Andrea; Gurunluoglu, Raffi; Djohan, Risal
Summary: Effective
postsurgical analgesia is a critical aspect of patient recovery. The goal of
this prospective, randomized, controlled, blinded study was to examine the
effect that liposomal bupivacaine delivered by means of a transversus abdominis
plane block has on pain control in women undergoing unilateral deep inferior
epigastric perforator flap reconstruction. Institutional review board approval
was granted for this prospective study. Patients were eligible if they were
undergoing unilateral, delayed deep inferior epigastric perforator flap
reconstruction. Patients were randomized to one of three groups: liposomal
bupivacaine transversus abdominis plane block, or bupivacaine pain pump. Charts
were reviewed for demographics, length of stay, and postoperative narcotic use.
There were eight patients in the liposomal bupivacaine and bupivacaine
transversus abdominis plane block groups and five patients in the pain pump
group. A retrospective cohort of six patients who did not receive any
intervention was included. Patients who received a liposomal bupivacaine
transversus abdominis plane block used statistically significantly less
intravenous and total postoperative narcotics in milligrams and milligrams per
kilogram per day compared with all other cohorts. They were able to get out of
bed at an earlier time point. Overall hospital costs were similar among the
groups. This is the first study to investigate liposomal bupivacaine delivered
as a transversus abdominis plane block in a prospective, randomized, blinded
study in women undergoing unilateral, delayed, abdominally based autologous
breast reconstruction. The authors were able to demonstrate a significant
reduction in intravenous and total narcotic use when a liposomal bupivacaine
transversus abdominis plane block was used. Future studies are needed to
prospectively investigate the effect that liposomal bupivacaine would have on
immediate and bilateral reconstructions.
