The Efficacy of Transversus Abdominis Plane (TAP) Blocks in Abdominal Tissue Free Flap Breast Reconstruction

Background: Regional blocks are effective adjuncts in autologous breast reconstruction. Data on specific regional blocks and agents remain unclear. Methods: We performed a retrospective review of patients that underwent abdominal free flap breast reconstruction between July 2017 and June 2022. A total of 256 patients were included with 181 that received Exparel TAP blocks, 54 with non-Exparel TAP blocks, and 21 without TAP block. Length of stay, ICU length of stay, average daily MME, and average total MME were collected. Results: Comparing the Exparel TAP Block cohort and Non-Exparel TAP Block cohort, there was no difference in LOS (2.71 vs. 2.72 days, p = 0.96), ICU LOS (0.35 vs. 0.56 days, p = 0.18), Daily MME (29.08 vs. 29.71 MME, p = 0.85), and Total MME (113.69 vs. 113.92 MME, p = 0.99). Comparing the Exparel TAP Block Cohort and Non-TAP Block cohort there were significant differences in LOS (2.71 vs. 3.62 days, p = 0.003), ICU LOS (0.35 vs. 1.1 days, p = 0.001), Daily MME (29.08 vs. 39.56, p = 0.04), and total MME (113.69 vs. 195.55, p = 0.001). When comparing the Non-Exparel TAP Block cohort and the Non-TAP Block cohort there were differences in LOS (2.72 vs. 3.62 days, p = 0.004), ICU LOS (0.56 vs. 1.1 days, p = 0.04), and total MME (113.92 vs. 195.55 MME, p = 0.006). Conclusion: TAP block can effectively reduce length of stay and post-operative narcotic use in patients undergoing autologous breast reconstruction regardless of the choice of local anesthetic.