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Defining Enhanced Recovery Pathway With Or Without Liposomal Bupivacaine In Diep Flap Breast Reconstruction
Ricardo Garza, Jr., B.S.1, Carolyn E. Boyle, MSN, CRNA1, Yulun Liu, PhD1, Yash Kadakia, B.A.1, Julie L. Cooper, B.S.1, Sami U. Khan, MD2, Nicholas T. Haddock, MD1, Sumeet S. Teotia, MD1.
1UT Southwestern, Dallas, TX, USA, 2Stony Brook University, Stony Brook, NY, USA.

PURPOSE: Enhanced Recovery After Surgery (ERAS) are multivariate interventions which have yielded positive outcomes in multiple surgical fields, although its function in reconstructive breast surgery has not been extensively explored. The authors aim to evaluate whether an ERAS protocol and its subsequent addition of liposomal bupivacaine affect patient outcomes.
METHODS: : Patients who underwent breast reconstruction with DIEP flaps from January 2016 to August 2019 were retrospectively reviewed. The ERAS protocol was implemented midway through 2017, and halfway through 2018, intraoperative TAP blocks with liposomal bupivacaine were added to the protocol. Such interventions allowed for comparison of 3 patient groups: pre-ERAS, ERAS, and ERAS + liposomal bupivacaine. Primary outcomes observed were postoperative opioid consumption and length of stay. P-values were obtained using the Wilcoxon test for pairwise comparisons.
RESULTS: After adjusting for ERAS compliance, 202 patients were analyzed. The pre-ERAS group was composed of 67 patients, ERAS of 69, and the ERAS + liposomal bupivacaine of 66. Postoperative opioid consumption was reduced when comparing the pre-ERAS and ERAS groups (275 to 146; p < 0.0001), and additionally reduced with the addition of liposomal bupivacaine (124; p = 0.09). Furthermore, hospital length of stay was decreased from 3.6 in the pre-ERAS group to 3.2 (p = 0.0029) in the ERAS, and to 2.6 (p < 0.0001) in the ERAS + liposomal bupivacaine groups.
CONCLUSION: ERAS protocols decrease postoperative opioid consumption and hospital length of stay in DIEP flap breast reconstruction. Addition of liposomal bupivacaine further strengthens the impact of the ERAS protocol.


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