Combined Continuous Paravertebral and TAP Blocks for Pain Management after TRAM Flap Breast Reconstruction: A Report of Two Cases

Transverse Rectus Abdominis Musculocutaneous (TRAM) flap surgery is a prolonged and extensive procedure that requires multiple incisions. Recently, Transverse Abdominis Plane (TAP) blocks have been found to be reliable method of providing regional analgesia for lower abdominal surgery and paravertebral block for pain management after breast surgery. Since the TRAM flap surgery involves both abdomen and thorax, the combination of these two blocks to manage post operative pain could be effective. This manuscript is one of the initial cases reporting of the use of these techniques in which triple catheters with ropivacaine infusion in breast reconstruction surgery were successfully used with reduced pain scores and opioid consumption.