Surgeon-delivered non-ultrasound-guided TAP blocks enhance recovery in DIEP flap breast reconstruction: A prospective comparative cohort study.

Abstract

Donor-site pain remains a major barrier to early recovery after deep inferior epigastric perforator (DIEP) flap breast reconstruction, despite advances in enhanced recovery after surgery (ERAS) pathways. Ultrasound-guided transversus abdominis plane (TAP) blocks delivered by anaesthetists perioperatively have shown benefit, but the role of a simple, surgeon-delivered, non-ultrasound guided TAP block during DIEP surgery, has not been systematically evaluated. A prospective comparative cohort study was conducted by including 88 patients undergoing immediate DIEP flap reconstruction after mastectomy. Patients treated before July 2023 served as controls (n=42), whereas those treated after the introduction of surgeon-administered TAP blocks served as the intervention group (n=46). TAP blocks were delivered at donor sites using 60 ml of 0.25% levobupivacaine. Primary endpoints included pain scores, opioid consumption and patient-controlled analgesia (PCA) lockouts. Secondary outcomes were mobilisation, bowel function and opioid-related side effects. TAP block patients reported significantly lower pain scores on postoperative day 0 (4.08±1.05 vs 2.78±0.97, p<0.001). Similar results were reported on postoperative days 1 and 2. TAP patients required fewer PCA doses on day 0 following surgery (10.3±5.52 vs 21±8.6, p<0.002). Postoperative days 1 and 2 showed similar effects. Significantly fewer PCA lockouts were recorded on day 0 (20.4+9.93 vs 3.9+2.31, p<0.006). Independent mobilisation occurred earlier (mean 2.0 vs 3.5 days, p<0.001), and opiate-related side effects particularly nausea and constipation were significantly reduced. A single-dose, surgeon-delivered, non-ultrasound guided TAP blocks provide effective, opioid-sparing analgesia and enhances recovery following DIEP flap reconstruction. This simple, reproducible and cost-effective technique offers surgeons direct control of postoperative analgesia and represents a valuable addition to ERAS pathways. Randomised trials are now warranted.