• Eric M Jablonka, Andreas M Lamelas, Julie N Kim, Bianca Molina, Nathan Molina, Michelle Okwali, William Samson, Mark R Sultan, Joseph H Dayan, and Mark L Smith.
• New York and Great Neck, N.Y.; and Irvine, Calif. From the Department of Surgery, Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai; the Department of Surgery, Division of Plastic Surgery, Mount Sinai Beth Israel Hospital; University of California, Irvine, School of Medicine; the Department of Surgery, Division of Plastic and Reconstructive Surgery, Mount Sinai West Hospital; the Department of Surgery, Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center; and the Department of Surgery, Division of Plastic Surgery, Northwell Health System.
• Plast. Reconstr. Surg. 2017 Aug 1; 140 (2): 240-251.

BackgroundSide effects associated with use of postoperative narcotics for pain control can delay recovery after abdominally based microsurgical breast reconstruction. The authors evaluated a nonnarcotic pain control regimen in conjunction with bilateral transversus abdominis plane blocks on facilitating early hospital discharge.MethodsA retrospective analysis was performed of consecutive patients who underwent breast reconstruction using abdominally based free flaps, with or without being included in a nonnarcotic protocol using intraoperative transversus abdominis plane blockade. During this period, the use of locoregional analgesia evolved from none (control), to continuous bupivacaine infusion transversus abdominis plane and catheters, to single-dose transversus abdominis plane blockade with liposomal bupivacaine solution. Demographic factors, length of stay, inpatient opioid consumption, and complications were reported for all three groups.ResultsOne hundred twenty-eight consecutive patients (182 flaps) were identified. Forty patients (62 flaps) were in the infusion-liposomal bupivacaine group, 48 (66 flaps) were in the single-dose blockade-catheter group, and 40 (54 flaps) were in the control group. The infusion-liposomal bupivacaine patients had a significantly shorter hospital stay compared with the single-dose blockade-catheter group (2.65 ± 0.66 versus 3.52 ± 0.92 days; p < 0.0001) and the control group (2.65 ± 0.66 versus 4.05 ± 1.26 days; p < 0.0001). There was no significant difference in flap loss or major complications among groups.ConclusionsWhen used as part of a nonnarcotic postoperative pain regimen, transversus abdominis plane blocks performed with single injections of liposomal bupivacaine help facilitate early hospital discharge after abdominally based microsurgical breast reconstruction. A trend toward consistent discharge by postoperative day 2 was seen. This could result in significant cost savings for health care systems.Clinical Question/Level Of EvidenceTherapeutic, III.

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