Prospective, Randomized, Controlled Comparison of Local Anesthetic Infusion Pump versus DepoFoam Bupivacaine For Pain Management After Unilateral Delayed Deep Inferior Epigastric Perforator Free Flap Reconstruction.

Background: Effective postsurgical analgesia is a critical aspect of patient recovery. The goal of this prospective, randomized, controlled, blinded study was to examine the effect that liposomal bupivacaine delivered via a transversus abdominis plane (TAP) block has on pain control in women undergoing unilateral deep inferior epigastic perforator reconstruction. Methods: IRB approval was granted for this prospective study. Patients were eligible if they were undergoing unilateral, delayed DIEP reconstruction. Patients were randomized to one of three groups; liposomal bupivacaine or bupivacaine TAP block or bupivacaine pain pump. Charts were reviewed for demographics, length of stay, and post-operative narcotic utilization. Results: There were eight patients in the liposomal bupivacaine and bupivacaine groups and 5 patients in the pain pump group. A retrospective cohort of six patients who did not receive any intervention was included. Patients who received a liposomal bupivacaine TAP block used statistically significantly less intravenous and total post-operative narcotics in mg and mg/kg/day compared to all other cohorts. They were able to get out of bed earlier time point. Overall hospital costs were similar amongst the groups. Conclusion: This is the first study to investigate liposomal bupivacaine delivered as a TAP block in a prospective, randomized, blinded study in women undergoing unilateral, delayed abdominally-based autologous breast reconstruction. We were able to demonstrate a significant reduction in intravenous and total narcotic utilization when a liposomal bupivacaine TAP block was utilized. Future studies are needed to prospectively investigate the effect that liposomal bupivacaine would have on immediate and bilateral reconstructions. There are no financial disclosures Corresponding Author: Risal Djohan, MD, Crile Building, Mail Code A60, 2049 East 100th Street, Cleveland, OH 44195, Email: Djohanr@ccf.org, Phone: 216-445-2433 ©2018American Society of Plastic Surgeons