Grants We Funded

Abstract
We are conducting a prospectively randomized, double-blinded, placebo-controlled trial to evaluate the effect of TAP blocks in patients undergoing autologous tissue breast reconstruction. We aim to explore the association between TAP block administration and post-operative breast reconstruction outcomes, as evaluated through narcotic and anti-emetic use, self-reported pain scores, and time to meeting discharge criteria.

For patients undergoing abdominal flap-based breast reconstruction for breast cancer, post-operative pain is often the limiting factor in recovery. Furthermore, poorly controlled pain in the acute post-operative period has been shown to predict the development of chronic pain syndromes in women diagnosed with breast cancer. Transversus abdominis plane (TAP) blocks have been shown to improve post-operative pain in a variety of abdominal surgeries, but have not been well studied in abdominal flap-based breast reconstruction, with previous studies differing in their placement and implementation of TAP blocks with varying results. We aim to validate the use of TAP blocks in breast reconstruction and use this knowledge to improve post-operative pain management in these patients.

For our study, patients undergoing abdominal flap-based breast reconstruction are enrolled and randomized to one of two groups: the true-TAP group to receive an infusion of bupivacaine, or the sham-TAP group to receive an infusion of saline. Randomization is done by our in-house pharmacy using computer-generated randomization lists, and all infusion bags are masked to ensure team members remain blinded. Bilateral TAP catheters are placed using ultrasound guidance pre-operatively and remain in place intra-operatively and through post-operative day two. All catheters are pre-programmed with the following infusion regimen for each side: 15 mL loading dose and 10 mL automated bolus infusion every four hours. All patients receive a standardized as needed pain regimen including a patient-controlled analgesia infusion, intravenous hydromorphone, and oral oxycodone, and patient-reported pain scores are recorded every four hours. Other outcomes of interest include anti-emetic usage, and time to meeting discharge criteria, as evaluated by patient's ability to ambulate and tolerate oral intake, return of bowel function, and adequate pain control on oral pain medications.

Biography
I completed my surgical training at University of California Los Angeles, followed by a Fellowship in Microsurgery at University of Texas M. D. Anderson Cancer Center. I joined the faculty at Stanford’s Department of Surgery in 2005, and have served as the Program Director for the Plastic Surgery Residency since 2008. My academic interests are in surgical education, training, simulation, and adipocyte stem cell biology. My research group has previously studied and published on complex microsurgical reconstructions, clinical outcomes as well basic science investigations into biomaterials, and adipocyte stem cells. My clinical practice and expertise is in complex reconstructive surgery of the head and neck, breast, extremity, genitalia, and abdominal wall. I have a diversified practice and work closely with other physicians in the Stanford Comprehensive Cancer Center to provide reconstructive plastic surgery services to a large patient base in the San Francisco Bay Area. I serve on several peer-reviewed journals, which include being the Associate Editor for the Annals of Plastic Surgery Journal, as well as serving on the editorial board for Microsurgery Journal. I am Board Certified by the America Board of Plastic Surgery, Inc.