Key result
Intraoperative placement of ultrasound-guided TAP catheters directly on the abdominal musculature during pedicled TRAM flap reconstruction resulted in low pain scores and reduced opioid consumption.
Why the study?
Pedicled TRAM flap breast reconstruction commonly results in significant pain at the donor abdominal site.
Case Report (n=1)
No
Intraoperative placement of ultrasound-guided TAP catheters directly on exposed abdominal musculature during TRAM flap breast reconstruction provided effective postoperative analgesia and reduced opioid consumption in a single patient.
Hypothesis-generating for TAP catheters in TRAM reconstruction; larger prospective trials needed before clinical adoption.
Transverse rectus abdominis (TRAM) flap reconstruction of the breast is a procedure in which a flap of skin, fat, and underlying rectus abdominis muscle is used to reconstruct the breast. This procedure is commonly performed after mastectomy and results in significant pain at the donor abdominal site. We present this case of a 50-year-old female undergoing pedicled TRAM flap surgery in which ultrasound-guided transversus abdominis plane (TAP) catheters were placed intraoperatively, in a novel fashion: under ultrasound guidance, directly on the abdominal musculature, without overlying fat, subcutaneous tissue, or dressing. Our case-reported numeric pain scores ranged from 0-5/10 during postoperative days one to two. The patient's IV morphine requirement on postoperative days zero to two ranged between 1.34 mg to 2.6 mg per day, representing a significant decrease compared to literature-reported opioid consumption after such surgery. Her pain and opioid consumption increased significantly after catheter removal, suggesting the efficacy of our intraoperative TAP catheters.
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Missett et al. (2023) conducted a case report in Breast reconstruction (pedicled TRAM flap) (n=1). Intraoperative ultrasound-guided transversus abdominis plane (TAP) catheters vs. Historical controls (literature-reported opioid consumption) was evaluated on Postoperative pain scores and opioid consumption. Intraoperative placement of ultrasound-guided TAP catheters directly on the abdominal musculature during pedicled TRAM flap reconstruction resulted in low pain scores and reduced opioid consumption.
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