203 posters, 14 topics, 5 sessions, 817 authors, 256 institutions
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The AAPS 102nd Annual Meeting
May 18-21, 2024 | The Westin Copley Place, Boston, MA
D142
The Impact Of Tumescent Local Anesthesia On Postoperative Pain And Opioid Use In DIEP Flap Breast Reconstruction
Poster Presenter
Authors
Maria J. Escobar-Domingo, Valeria P. Bustos, Benjamin Rahmani, Daniela Lee, John Park, Tessa Campbell, Jose A. Foppiani, Samuel J. Lin, Bernard T. Lee
Affiliations
Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Miami, Miami, FL, USA
Part of Topic
Breast Reconstruction
The Impact of Tumescent Local Anesthesia on Postoperative Pain and Opioid Use in DIEP Flap Breast Reconstruction
Background: The opioid epidemic continues to pose significant public health challenges, with reported costs exceeding $1.02 trillion in 2017 due to opioid use and fatal overdoses. In efforts to enhance postoperative pain control and reduce the risk of opioid misuse, our team has implemented the use of tumescent local anesthesia with bupivacaine (TLA) in DIEP flap breast reconstruction for both the breast and abdominal donor-site.
Objectives: This study aims to evaluate the impact of tumescent local anesthesia on postoperative pain and opioid use in patients undergoing DIEP flap breast reconstruction.
Methods:
•An institutional retrospective study on patients who underwent DIEP flap BR from 2018 to 2023 was conducted.
•Patients were categorized by TLA use:
•Tumescent: Tumescent fluid and Bupivacaine as a TAP block and intercostal and local anesthetic block.
•No Tumescent: TAP block alone (Bupivacaine)
•Multivariable linear regression models evaluated differences between groups.
Results: Univariate analyses revealed significant lower rates of hematoma in the tumescent group. No significant differences in other postoperative complications were found between groups. Linear regression models demonstrated an average inpatient opioid use of 29.4 MME (morphine milligram equivalent) lower than the control group (95% CI [-45,29,-13.45]; p<0.001). Additionally, TLA had an average opioid prescribed at discharge of 36.1 MME lower than the control group (95% CI, [-58.27,-13.98]; p<0.001).
Conclusions: Our findings suggest that the use of TLA during DIEP flap breast reconstruction is significantly associated with reduced opioid consumption both during hospitalization and post-discharge. Using a multimodal strategy for pain reduction, our study proposes a strategy to potentially decrease opioid misuse.