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Efficacy Of Adjunct Dexamethasone With Bupivacaine For Transversus Abdominis Plane Blocks In Patients Undergoing Autologous Breast Reconstruction
Hallie Tolo, MD,
Angad S. Sidhu, BS, Louis Massoud, MD, Chelsea Fathauer, BS, Ravinder Bamba, MD, Jason R. VonDerHaar, MD, Aladdin H. Hassanein, MD, MMSc, Mary E. Lester, MD, Rachel M. Danforth, MD.
Indiana University School of Medicine, Indianapolis, IN, USA.
PURPOSE: Deep Inferior Epigastric Perforator (DIEP) flap is the most common form of autologous breast reconstruction. Enhanced recovery protocols often include transversus abdominis plane (TAP) blocks using liposomal bupivacaine, but cost limits use. Dexamethasone added to bupivacaine is a low-cost strategy to prolong block duration. We compared the efficacy of liposomal bupivacaine to bupivacaine with dexamethasone for TAP blocks in DIEP patients.
METHODS:A retrospective single-institution cohort (2018-2023) of DIEP patients receiving intraoperative, ultrasound-guided TAP blocks was identified. Two groups were created: Group 1 (liposomal bupivacaine (Exparel; Pacira Biosciences, Inc, Parsippany, New Jersey)) and Group 2 (30 mL 0.25% bupivacaine + 1 mg dexamethasone). Outcomes included length of stay (LOS), total postoperative morphine milligram equivalents (MME), and Numeric Pain Rating Scale scores. Demographics were assessed and p<0.05 were considered significant.
RESULTS:Among 178 patients (Group 1: 95; Group 2: 83), there was no difference in age, BMI>30 kg/m2, smoking status, and laterality of reconstruction across cohorts. Group 2 had a shorter LOS (2.88 days vs 3.49 days; p<0.001), lower total post-operative MME usage (70.6 ± 60.0 vs 104.7 ± 72.8; p<0.001), and lower pain scores (3.44 ± 1.50 vs 4.53 ± 1.57; p<0.001) on post-operative day one compared to Group 1. No differences were noted in pain scores on subsequent post-operative days (POD 2, 3, 4).
CONCLUSION:TAP blocks using dexamethasone with bupivacaine added may represent a cost-effective and clinically effective alternative approach for post-operative pain management during DIEP flap breast reconstruction compared to commercially marketed liposomal bupivacaine.
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