Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia.
Hansjörg Wyss Department of Plastic Surgery, New York University School of Medicine, New York, New York.
J Reconstr Microsurg. 2020 Jun;36(5):353-361. doi: 10.1055/s-0040-1701663. Epub 2020 Feb 23.
Transversus abdominis plane (TAP) blocks have been shown to significantly reduce pain and narcotic consumption following major abdominal surgeries. This study investigates the literature on their use in microsurgical breast reconstruction.
A systematic review of TAP blocks in autologous breast reconstruction was performed.
Across 10 included studies, 174 patients (5 studies) received an intraoperative TAP block injection, 185 patients (4 studies) received a TAP catheter for intermittent postoperative analgesia, and 325 patients served as controls for a total of 684 included patients. The majority of TAP block delivery techniques were ultrasound guided (7/10 studies). Liposomal bupivacaine (LB) was the most commonly used analgesic (4 studies and139 patients) followed by conventional bupivacaine (3 studies and 105 patients). Eight studies found a significant reduction in oral, intravenous, and/or total morphine requirements in the TAP group when either the daily average and/or total inpatient consumption was compared with the control. Hospital length of stay was significantly shorter for patients undergoing single intraoperative TAP block injection with any analgesic as compared with standard narcotic-based protocols (mean difference= -0.95 days; 95% CI: -1.72 to -0.17 days; = 0.02). Looking at TAP blocks specifically with LB, there was a mean decrease of 0.83 days as compared with the control, which was not statistically significant (95% CI: -1.90 to 0.25 days; = 0.13).
While the current data support the use of TAP blocks in autologous breast reconstruction, additional studies with more standardized protocols should be performed to determine the most optimal practice.
腹横肌平面（TAP）阻滞已被证明可显著减少大腹部手术后的疼痛和阿片类药物的消耗。本研究调查了 TAP 阻滞在显微乳房重建中的应用文献。
对 TAP 阻滞在自体乳房重建中的应用进行了系统回顾。
在纳入的 10 项研究中，有 174 例患者（5 项研究）接受了术中 TAP 阻滞注射，185 例患者（4 项研究）接受了 TAP 导管用于间断术后镇痛，325 例患者作为对照组，共纳入 684 例患者。大多数 TAP 阻滞给药技术为超声引导（7/10 项研究）。脂质体布比卡因（LB）是最常用的镇痛剂（4 项研究和 139 例患者），其次是常规布比卡因（3 项研究和 105 例患者）。8 项研究发现，与对照组相比，TAP 组无论是每日平均还是总住院阿片类药物消耗量，口服、静脉和/或总吗啡需求量均显著减少。与标准基于阿片类药物的方案相比，接受单次术中 TAP 阻滞注射任何镇痛剂的患者住院时间明显缩短（平均差异=-0.95 天；95%置信区间：-1.72 至-0.17 天； = 0.02）。专门观察 TAP 阻滞联合 LB 时，与对照组相比，平均住院时间缩短了 0.83 天，但无统计学意义（95%置信区间：-1.90 至 0.25 天； = 0.13）。
虽然目前的数据支持 TAP 阻滞在自体乳房重建中的应用，但应进行更多标准化方案的研究，以确定最佳实践。
