INTRODUCTION: Abdominally-based tissue has become the preferred technique for many women with breast cancer who are underdoing a mastectomy and do not desire implant- based reconstruction. However, the additional abdominal dissection results in increased pain post-operatively, requiring additional narcotic usage. It has been our mission to improve pain control following this reconstruction with the aims of facilitatating patients’ recovery while decreasing narcotic usage, hospital stays and overall treatment costs. The transversus abdominis plane (TAP) block uses a local anesthetic to block the nerves supplying sensation to abdominal wall. Bupivacaine is the most commonly used anesthetic and can be injected plain or as a newer liposomal formula (Exparel®), which has sustained release and lasts three to four days. It is not currently known if either of these delivery methods provides a better pain relief.
METHODS: IRB approval was granted to recruit women undergoing mastectomy with abdominal-based tissue reconstruction to be randomized to one of two study groups: a Transversus Abdominis Plane (TAP) block performed with either bupivacaine or liposome bound bupivacaine (Exparel®), a sustained relief pain medication. A retrospective control cohort consisting of six consecutive previously reconstructed patients who did not receive a TAP block were also identified. Pain was assessed using a subjective 1–5 pain scale, both at rest and after coughing, an abdominal specific assessment. Pain, nausea, emesis and activity were assessed at six, twelve, twenty-four, thirty-six and seventy-two hours. Total narcotic usage was calculated for hospital stay.
RESULTS: From 2016, a total of sixteen patients have been enrolled: Exparel® (eight) and bupivacaine (eight). Patients who received Exparel® had a shorter average length of hospital stay as compared to the bupivacaine and control groups (4, 4.6 and 4.8 days). The Exparel® group demonstrated better sustained subjective pain control across time points both at baseline and during coughing. Oral, intravenous, and total narcotic usages (mg/body weight/day) were significantly less in the Exparel® group compared to the bupivacaine and control groups.
CONCLUSION: Our preliminary results suggest that delivering Exparel® via a TAP block in abdominal-based breast reconstruction can result in decreased hospital stays and narcotic usage with improved pain control.