Liposomal Bupivacaine in Transversus Abdominis Plane Block for Postoperative Pain Control After Autologous Breast Reconstruction: A Systematic Review and Meta-Analysis.

Abstract

Autologous breast reconstruction using abdominally based flaps is common post-mastectomy, but donor-site pain often leads to prolonged opioid use. The transversus abdominis plane (TAP) block is a common regional anesthesia technique, with bupivacaine as the standard anesthetic. Liposomal bupivacaine (LB), a prolonged-release formulation, aims to extend pain relief and reduce opioid consumption, though its efficacy remains debated. This systematic review and meta-analysis compared LB versus plain bupivacaine (PB) in TAP blocks for autologous breast reconstruction, focusing on opioid consumption, pain scores, and hospital stay. A systematic search identified randomized controlled trials and observational studies comparing LB (with or without PB) to PB in TAP blocks. Data were pooled using a random-effects model (I² ≥ 25%) or fixed-effects model (I² < 25%). Six studies (429 patients) met inclusion criteria. LB was associated with significant reduction in opioid consumption on postoperative days (POD) 1 (MD = -4.99 mg; 95% CI: [-8.42; -1.56], p < 0.01, I² = 0%) and POD 2 (MD = -3.35 mg; 95% CI: [-5.74; -0.96], p < 0.01, I² = 0%). Pain scores were significantly lower on POD 2 and POD 3. No difference in hospital stay was found (MD = -0.17; 95% CI: [-0.52; 0.18], p = 0.34, I² = 83.1%). LB reduced opioid consumption during the first 48 h postoperatively and modestly improved pain control on POD 2 and POD 3, but did not shorten hospital stay. Further large-scale RCTs are needed to validate its benefits.