Objective
Breast reconstruction with microvascular autologous tissue has gradually evolved. Enhanced recovery after surgery was also adopted for optimizing results. The purpose of this study was to compare outcomes of patients undergoing autologous tissue-based reconstruction before and after the implementation of a multimodal pain control program.

Material and Methods
This was a retrospective study that included 69 patients who had breast cancer with microvascular autologous tissue-based breast reconstruction from 2015 to 2020. Intravenous patient-controlled analgesia (PCA) was gradually substituted with preoperative regional block (RB), transversus abdominis plane block (TAP) or quadratus lumborum block (QL). Patients demographics, operative details and postoperative data were collected from patients’ medical records. The primary endpoints were hospital length of stay and total postoperative opioid consumption.

Results
There were totally 69 consecutive patients included and analyzed (convention group, n=48; multi-modal group, n=21). Mean length of hospital stay (10.4 days versus 10.3 days, p=0.652) and visual analogue scale (VAS) were no significant difference. Total postoperative morphine equivalent consumption was lower in the group of regional block and transversus abdominis plane block (112 mg versus 26 mg, p<0.001).

Conclusions
The adoption of preoperative RB, TAP or QL for microvascular autologous tissue-based breast reconstruction decreased opioid consumption without increased complications.

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