Transverse abdominis plane (TAP) and rectus sheath (RS) blocks are utilized in enhanced recovery after surgery protocols, but with highly variable methodologies and outcomes in reported literature. The purpose of this study was to evaluate the efficacy of abdominal peripheral nerve blocks in free flap breast reconstruction as they pertain to postoperative pain medication requirements and hospital length of stay (LOS).

Retrospective review was conducted on patients undergoing breast reconstruction with deep inferior epigastric artery perforator free flaps at a large academic institution. Target variables included history of chronic pain diagnosis, laterality, and nerve block type (TAP or RS). Outcomes included daily and total opioid oral morphine milligram equivalents on postoperative days one to three. Patient cohorts were analyzed by TAP block, RS block, or no block. Blocks were performed intraoperatively by the surgical team.

Between 2021 and 2023, 225 patients met the inclusion criteria; 87 received TAP blocks, 72 received RS blocks, and 66 received no block. Patients with chronic pain diagnoses who underwent bilateral reconstruction had higher total postoperative opioid requirements. There were no significant differences in hospital LOS or postoperative pain medication requirements between the three groups before or after controlling for multiple co-variables.

In this large cohort of abdominal-based free flap breast reconstruction patients, there was no impact of peripheral nerve block or nerve block type on postoperative pain medication requirement or hospital LOS. Bilateral flap reconstruction and a history of chronic pain diagnoses were the only factors found to affect perioperative opioid utilization in patients undergoing abdominally based breast reconstruction.

Presented at: this project was accepted as a podium presentation to the American Society of Reconstructive Microsurgery's Annual Meeting in January 2025.

Received: 30 January 2025

Accepted: 26 July 2025

Article published online:
14 August 2025

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