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Blinded Randomized Control Trial Investigating Pain Control and Length of Stay Measures with Transversus Abdominis Plane Block Performed with Liposomal Bound Bupivicaine (Exparel®) in Women Undergoing
James Gatherwright, MD; Amir Ghaznavi, MD; Rebecca Knackstedt, MD, PhD; Risal Djohan, MD
Cleveland Clinic
2017-02-10
Presenter: Rebecca Knackstedt
Affidavit:
Steven Bernard
Director Name: Steven Bernard
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Background: Abdominally-based tissue has become the preferred choice for many women with breast cancer who are underdoing a mastectomy and do not desire implant- based reconstruction. However, the additional abdominal dissection results in increased pain post-operatively, requiring additional narcotic usage. It has been our mission to make improvement in pain control following this reconstruction with the aims to facilitate patients' recovery while decreasing narcotic usage, hospital stays and overall treatment costs.
Methods: IRB approval was granted to recruit women undergoing mastectomy with abdominal-based tissue reconstruction to be randomized to one of two study groups: a Transversus Abdominis Plane (TAP) block performed with either bupivacaine or liposome bound bupivacaine (Exparel®). A retrospective control cohort consisting of six consecutive previously reconstructed patients who did not receive a TAP block were also identified.
Results: A total of sixteen patients have been enrolled: Exparel® (eight) and bupivacaine (eight). Patients who received Exparel® had a shorter average length of hospital stay as compared to the bupivacaine and control groups (4, 4.6 and 4.8 days). The Exparel® group demonstrated better sustained subjective pain control across time points both at baseline and during coughing, an abdominal site specific measure. Oral, intravenous, and total narcotic usages (mg/body weight/day) were significantly less in the Exparel® group compared to the bupivacaine and control groups.
Conclusion: Our preliminary results suggest that delivering Exparel® via a TAP block in abdominal-based breast reconstruction can result in decreased hospital stays and narcotic usage with improved pain control.
