Hunter Cedric, Shakir Afaaf, Momeni Arash, Luan Anna, Steffel Lauren, Horn Jean-Louis, Nguyen Dung, Lee Gordon K
From the *Division of Plastic Surgery, and †Department of Anesthesia, Stanford University Medical Center, Palo Alto, CA.
Ann Plast Surg. 2017 Mar;78(3):254-259. doi: 10.1097/SAP.0000000000000873.
The use of the transversus abdominis plane (TAP) block is increasing in abdominally based autologous tissue breast reconstruction as a method to provide postoperative donor site analgesia. The purpose of this study was to evaluate the efficacy of the TAP block in the immediate postoperative period.
A retrospective analysis of all patients who underwent autologous microsurgical breast reconstruction over a 2-year period (2013-2015) was conducted. Only patients with an abdominal donor site were included. Patients were grouped based on the presence or absence of TAP blocks. Primary endpoints included patient-reported pain score, daily and total narcotic use during the hospitalization, antiemetic use, as well as complications.
We identified 40 patients that had undergone abdominal-based free flap breast reconstruction and TAP block catheter placement for postoperative analgesia that met inclusion criteria. This group was then compared with a matched cohort of 40 patients without TAP blocks. There were no complications associated with using the TAP catheters. There was no statistically significant difference in postoperative pain scores, daily or total narcotic use during the hospitalization, or antiemetic use between the 2 groups. Although not statistically significant, linear regression analysis identified trends of improved donor site analgesia in select groups, such as unilateral immediate reconstructions, body mass index greater than 30 kg/m, and those without abdominal mesh placed at the time of donor site closure in the TAP block group.
Constant delivery of local anesthetic through the TAP block appears to be safe; however, it did not reduce narcotic requirements or postoperative pain scores in patients undergoing abdominal-based free flap breast reconstruction.
腹直肌平面（TAP）阻滞作为一种提供术后供区镇痛的方法，在基于腹部的自体组织乳房重建中的应用日益增多。本研究的目的是评估TAP阻滞在术后即刻的疗效。
对2013年至2015年期间接受自体显微外科乳房重建的所有患者进行回顾性分析。仅纳入腹部供区的患者。根据是否进行TAP阻滞对患者进行分组。主要终点包括患者报告的疼痛评分、住院期间每日和总的麻醉药物使用量、止吐药使用情况以及并发症。
我们确定了40例接受基于腹部的游离皮瓣乳房重建并放置TAP阻滞导管用于术后镇痛且符合纳入标准的患者。然后将该组与40例未进行TAP阻滞的匹配队列进行比较。使用TAP导管未出现并发症。两组在术后疼痛评分、住院期间每日或总的麻醉药物使用量或止吐药使用方面无统计学显著差异。尽管无统计学显著差异，但线性回归分析确定了某些组（如单侧即刻重建、体重指数大于30 kg/m²以及在TAP阻滞组供区关闭时未放置腹部补片的患者）供区镇痛改善的趋势。
通过TAP阻滞持续给予局部麻醉药似乎是安全的；然而，它并未降低接受基于腹部的游离皮瓣乳房重建患者的麻醉药物需求量或术后疼痛评分。
