The efficacy of anterior quadratus lumborum blocks as an alternative to transversus abdominis plane blocks as part of an enhanced recovery after surgery pathway for abdominal based breast reconstruction: A pilot study
Brogan G. Evans*, Haripriya Ayyala
Surgery (Division of Plastic Surgery), Yale-New Haven Hospital, New Haven, CT
Regional blocks have demonstrated improved patient outcomes in enhanced recovery after surgery (ERAS) protocols for breast reconstruction. While the transversus abdominis plane (TAP) block is the most widely used regional block in autologous breast reconstruction, there is limited data comparing the efficacy of different block types in breast surgery. The purpose of this study is to evaluate the efficacy of the anterior quadratum lumborum block (aQLB) compared to the TAP block as part of a breast reconstruction ERAS pathway.
72/170 patients received an intra-operative, bilateral TAP block by the operating surgeon. 98/170 patients received a preoperative, bilateral aQLB by an anesthesiologist. All patients underwent breast reconstruction with deep inferior epigastric artery perforator (DIEP) flaps (72/170 unilateral, 98/170 bilateral), with reconstruction performed immediately (n = 118) or delayed (n=52) following mastectomy. Pain scores, average daily opioid consumption, length of stay (LOS), and post-operative venous thromboembolism (VTE) events were compared using a standard t-test. Median and interquartile ranges (IQR) were calculated using a non-parametric Wilcoxon rank sum test.
Preoperative aQLB a significantly lower post-operative daily milligram morphine (MME) consumption when compared to intra-operative TAP blocks (Median (IQR) 23.4mg (7.4mg, 42.0mg) to 9.7mg (3.8mg, 19.4mg), p<0.001). This data maintained statistical significance across all subvariant analyses, except in patients who underwent delayed unilateral reconstruction. Average daily pain scores, LOS, and incidence of VTE events were not statistically different between regional blocks.
Pre-operative aQLB are an effective alternative the conventional surgeon placed TAP block in reducing post-operative opioid use in autologous breast reconstruction. Length of stay, subjective pain scores, and post-operative VTE rates were found to be non-inferior for the aQLB compared to the TAP block.
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