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Research article

Efficacy of ultrasound-guided transversus abdominis plane block in breast reconstruction surgery with abdominal myocutaneous flap

Authors:

Ana Luísa Afonso ,

Instituto de Oncologia do Porto, Francisco Gentil, EPE, Porto, PT
About Ana Luísa
Resident in Anaesthesiology
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Luís Pereira,

Centro Hospitalar do S. João, EPE, Porto, PT
About Luís
Assitant of Anaesthesiology
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Joana Correia,

Instituto de Oncologia do Porto, Francisco Gentil, EPE, Porto, PT
About Joana
Resident in Anaesthesiology
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Mónica Ferreira,

Instituto de Oncologia do Porto, Francisco Gentil, EPE, Porto, PT
About Mónica
Resident in Anaesthesiology
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Nuno Lareiro,

Centro Hospitalar Baixo-Vouga, EPE, Aveiro, PT
About Nuno
Resident in Anaesthesiology
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Joana Filipa Paulo,

Instituto de Oncologia do Porto, Francisco Gentil, EPE, Porto, PT
About Joana Filipa
Resident in Anaesthesiology
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Germano Cardoso,

Instituto de Oncologia do Porto, Francisco Gentil, EPE, Porto, PT
About Germano
Graduate Assitant in Anaesthesiology
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Luís Botelho Antunes,

Instituto de Oncologia do Porto, Francisco Gentil, EPE, Porto, PT
About Luís Botelho
Epidemiologist, Department of Clinical Epidemiology
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Rui Valente

Instituto de Oncologia do Porto, Francisco Gentil, EPE, Porto, PT
About Rui
Graduate Assitant in Anaesthesiology
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Abstract

Background: Ultrasound (US)-guided transversus abdominis plane block (TAPB) provides postoperative analgesic efficacy in abdominal surgery, however evidence of its efficacy in reconstructive breast surgery with transversus rectus abdominis myocutaneous (TRAM) flap is still limited. Our main objective was to assess effectiveness of TAPB in this surgery.

 

Methods: Observational retrospective study conducted in patients undergoing unilateral breast reconstruction with TRAM (surgery 1) and mastectomy (partial or total) followed by TRAM reconstruction (surgery 2) from April 2015 to June 2017. Two anaesthetic plans were analysed: general balanced anaesthesia (GBA) and combined GBA with bilateral TAPB (GBA+TAPB). Primary outcomes were total intraoperative administered fentanyl, total consumed morphine in postoperative anaesthesia care unit (PACU) and time between conclusion of surgery and first requested analgesic (analgesia time).

 

Results: 107 patients were included: 80 submitted to surgery 1 and 27 submitted to surgery 2. In surgery 1, intraoperative fentanyl consumption and administered morphine, during the patients’ stay at PACU, were lower in GBA+TAPB than in GBA group (p<0.001). A longer analgesia time was identified in GBA+TAPB group (p=0.026). Considering surgery 1, at admission at PACU, GBA+TAPB referred lower pain intensity at rest (p=0.049) and on movement (p=0.001), as well as at the 4th postoperative hour, at rest (p=0.005) and on movement (p=0.011). Modified Aldrete scores were higher in GBA+TAPB group (p=0.009).

 

Regarding surgery 2, globally no significant differences were identified between both groups.

 

No complications associated to local anaesthetics or TAPB were registered.

 

Conclusion: US-guided bilateral TAPB resulted in lower opioid consumption and better pain control in unilateral breast reconstruction surgery with TRAM.
How to Cite: Afonso, A.L., Pereira, L., Correia, J., Ferreira, M., Lareiro, N., Paulo, J.F., Cardoso, G., Antunes, L.B. and Valente, R., 2019. Efficacy of ultrasound-guided transversus abdominis plane block in breast reconstruction surgery with abdominal myocutaneous flap. Sri Lankan Journal of Anaesthesiology, 27(1), pp.59–67. DOI: http://doi.org/10.4038/slja.v27i1.8396
Published on 06 Feb 2019.
Peer Reviewed

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