Work

Liposomal Bupivacaine in Transversus Abdominis Plane Block for Postoperative Pain Control After Autologous Breast Reconstruction: A Systematic Review and Meta‐Analysis

Year: 2025

Type: review

Study designs: Systematic Review, Meta-Analysis

Abstract: ABSTRACT Background Autologous breast reconstruction using abdominally based flaps is common post‐mastectomy, but donor‐site pain often leads to prolonged opioid use. The transversus abdominis plane ( TAP ) block is a common regional anesthesia technique, with bupivacaine as the standard anesthetic. Liposomal bupivacaine ( LB ), a prolonged‐release formulation, aims to extend pain relief and reduce opioid consumption, though its efficacy remains debated. Objective This systematic review and meta‐analysis compared LB versus plain bupivacaine ( PB ) in TAP blocks for autologous breast reconstruction, focusing on opioid consumption, pain scores, and hospital stay. Methods A systematic search identified randomized controlled trials and observational studies comparing LB (with or without PB ) to PB in TAP blocks. Data were pooled using a random‐effects model ( I 2 ≥ 25%) or fixed‐effects model ( I 2 < 25%). Results Six studies (429 patients) met inclusion criteria. LB was associated with significant reduction in opioid consumption on postoperative days ( POD ) 1 ( MD = −4.99 mg; 95% CI : [−8.42; −1.56], p < 0.01, I 2 = 0%) and POD 2 ( MD = −3.35 mg; 95% CI : [−5.74; −0.96], p < 0.01, I 2 = 0%). Pain scores were significantly lower on POD 2 and POD 3. No difference in hospital stay was found ( MD = −0.17; 95% CI : [−0.52; 0.18], p = 0.34, I 2 = 83.1%). Conclusion LB reduced opioid consumption during the first 48 h postoperatively and modestly improved pain control on POD 2 and POD 3, but did not shorten hospital stay. Further large‐scale RCTs are needed to validate its benefits.

Source: Microsurgery

DOI: 10.1002/micr.70126