Deep Inferior Epigastric Perforator (DIEP) flap is the most common form of autologous breast reconstruction. Enhanced recovery protocols often include transversus abdominis plane (TAP) blocks using liposomal bupivacaine, but cost limits use. Dexamethasone added to bupivacaine is a low-cost strategy to prolong block duration. We compared the efficacy of liposomal bupivacaine to bupivacaine with dexamethasone for TAP blocks in DIEP patients. A retrospective single-institution study (2018–2023) of DIEP patients receiving intraoperative, ultrasound-guided TAP blocks were identified and divided into two: Group 1 (commercially-available liposomal bupivacaine) and Group 2 (30 mL 0.25% bupivacaine + 1 mg dexamethasone). Outcomes included length of stay (LOS), total post-operative morphine milligram equivalents (MME), and Numeric Pain Rating Scale scores. Demographics were assessed and p30 kg/m 2 , smoking status, laterality, perforator selection, and wound complications across cohorts. Group 2 had a shorter LOS (2.88 days vs 3.49 days; p<0.001), lower total post-operative MME usage (70.6 ± 60.0 vs 104.7 ± 72.8; p<0.001), and lower pain scores (3.44 ± 1.50 vs 4.53 ± 1.57; p<0.001) on post-operative day one compared to Group 1. No differences were noted in pain scores on subsequent post-operative days (POD 2, 3, 4). TAP blocks using dexamethasone with bupivacaine added may represent a cost-effective and clinically effective alternative approach for post-operative pain management during DIEP flap breast reconstruction compared to commercially marketed liposomal bupivacaine.
Tolo et al. (Fri,) studied this question.