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Breast cancer is the second most common cancer diagnosed in American women . For patients who have undergone surgical mastectomy, autologous breast reconstruction is an alternative option to breast implants. Deep Inferior Epigastric Perforator (DIEP) flaps are the gold standard for autologous breast reconstruction . Effective pain control following surgery is imperative and ultrasound-guided bilateral transversus abdominis plane blocks (TAPs) with the infiltration of local anesthetics, such a ropivacaine are a common regional technique of choice . A newer described technique, bilateral Erector Spinae Plane blocks (ESPBs) (which also are an infiltration of local anesthetic) present as an alternative approach for post-operative analgesia. ESPBs have been proven efficacious in reducing intra- and post-operative opioid requirements, lessening the need for rescue analgesics in other similar surgical procedures.
The hypothesis is that preoperative bilateral ESPBs could provide equivalent pain control as a regional analgesic for patients undergoing DIEP flap surgery when compared to preoperative bilateral TAPs
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Group 1: Erector Spinae Plane blocks | Other | Erector Spinae Plane blocks |
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| Group 2: Transversus Abdominis Plane blocks | Other | Transversus Abdominis Plane blocks |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Pre-operative Erector Spinae Plane block prior to DIEP surgery | Procedure | After obtaining informed consent to participate in the study, patients will be randomized by a computer 50/50 to either the Erector Spinae Plane group or the Transversus Abdominus Plane group at the time of their surgical clinic visit prior to their scheduled surgery. Then on the morning of surgery, the Erector Spinae Plane group will receive a bilateral ultrasound-guided Erector Spinae Plane peripheral nerve block. During this intervention, 0.25% ropivacaine will be injected below the fascia of the erector spinae muscle group. |
| Measure | Description | Time Frame |
|---|---|---|
| Numerical Rating Scale | Scale used to measure pain on scale from 0-10 (0 is 'no pain' and 10 is 'the worst pain imaginable') | 24 hours post injection |
| Mean Morphine Equivalents | Amount of opioid pain medications administered and converted to morphine equivalents | 24 hours post injection |
| Measure | Description | Time Frame |
|---|---|---|
| Numerical Rating Scale | Scale used to measure pain on scale from 0-10 (0 is 'no pain' and 10 is 'the worst pain imaginable') | 12 hours post injection |
| Michigan Body Map | Map used to show body location of worst site of primary pain |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Rachel Keller | Contact | 9139458072 | rkeller@kumc.edu | |
| Manuel Clark | Contact | 9139455763 | mclark16@kumc.edu |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Kansas Medical Center | Recruiting | Kansas City | Kansas | 66160 | United States |
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| ID | Term |
|---|---|
| D010146 | Pain |
| ID | Term |
|---|---|
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
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The principal investigator will be unblinded. The study coordinator will be blinded, unable to access procedure notes and randomization assignment
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| Pre-operative Transversus Abdominus Plane blocks prior to DIEP surgery | Procedure | On the morning of surgery, the patients in the TAPs group will receive a bilateral ultrasound-guided Transversus Abdominus plane peripheral nerve block. During this intervention, 0.25% ropivacaine will be injected into the transversus abdominus plane above the transversus abdominus muscle. |
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| 24 hours post injection |
| Mean Morphine Equivalents | Amount of opioid pain medications administered and converted to morphine equivalents | 48 hours post injection |
| Numerical Rating Scale | Scale used to measure pain on scale from 0-10 (0 is 'no pain' and 10 is 'the worst pain imaginable') | 48 hours post injection |
| Numerical Rating Scale | Scale used to measure pain on scale from 0-10 (0 is 'no pain' and 10 is 'the worst pain imaginable') | 1 week post-operation |
| Numerical Rating Scale | Scale used to measure pain on scale from 0-10 (0 is 'no pain' and 10 is 'the worst pain imaginable') | 2 weeks post-operation |
| Numerical Rating Scale | Scale used to measure pain on scale from 0-10 (0 is 'no pain' and 10 is 'the worst pain imaginable') | 6 weeks post-operation |