Comparative Effectiveness of Transversus Abdominis Plane Blocks in Abdominally Based Autologous Breast Reconstruction: A Systematic Review and Meta-analysis
Year: 2019
Type: article
Study designs: Systematic Review, Meta-Analysis
Abstract: PURPOSE: Abdominally based autologous breast reconstruction is the most common autologous reconstruction option following mastectomy. However, the abdominal donor site contributes significantly to postoperative pain, resulting in increased opioid use, length of stay (LOS), and hospital costs.1 The advent of enhanced recovery after surgery pathways in breast reconstruction has demonstrated reductions in LOS; however, these protocols are not typically uniform and utilize many differing techniques.2,3 Transversus abdominis plane (TAP) blocks have been reported to decrease these adverse outcomes. Given the influx of new studies on the technique and lack of a systematic review and meta-analysis, the literature was investigated to elucidate the evidence for TAP blocks as a potential driver of the benefit seen in enhanced recovery after surgery pathways. METHODS: A systematic review was registered with PROSPERO and conducted according to PRISMA guidelines in an effort to perform a meta-analysis. Relevant studies reporting TAP block for abdominally based breast reconstruction were extracted from PubMed, Embase, Cochrane, Scopus, and Clinicaltrials.gov before February 2019 and pooled for comparison. The outcomes examined were total opioid use, postoperative pain, LOS, and hospital costs. RESULTS: The initial search yielded 1,520 studies, ultimately narrowed to 12. A total of 1,007 patients were followed with 492 receiving TAP block perioperatively and 515 serving as controls without TAP block. For these selected outcomes of interest, 10 of 12 (83.3%) opioid use studies, 5 of 9 (55.6%) postoperative pain studies, 6 of 9 (66.7%) LOS studies, and 2 of 3 (66.7%) cost studies revealed significant benefits following TAP block. There was no significant difference in complication rate between TAP and without TAP blocks in any study. CONCLUSION: Optimizing postoperative pain management following abdominally based breast reconstruction is invaluable for patient recovery. Based on this systematic review, the TAP block is associated with a reduction in LOS and opioid use, representing a safe and reasonable strategy for reducing the postoperative pain burden. REFERENCES: 1. Panchal H, Matros E. Current trends in postmastectomy breast reconstruction. Plast Reconstr Surg. 2017;140:7S–13S. doi:10.1097/PRS.0000000000003941. 2. Sebai ME, Siotos C, Payne RM, et al. Enhanced recovery after surgery pathway for microsurgical breast reconstruction: a systematic review and meta-analysis. Plast Reconstr Surg. 2019;143:655–666. doi:10.1097/PRS.0000000000005300. 3. optiFLAPP Collaborative. Variation in the perioperative care of women undergoing abdominal-based microvascular breast reconstruction in the United Kingdom (The optiFLAPP Study). J Plast Reconstr Aesthet Surg. 2019;72:35–42. doi:10.1016/j.bjps.2018.08.007.
Authors: David Chi, Austin D. Chen, Bernard T. Lee
Institutions: Beth Israel Deaconess Medical Center, Harvard University
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,195
OpenAlex ID: W2972376668