www.PRSJournal.com 870 A utologous tissue breast reconstruction tech- niques have evolved to restore mastectomy defects with minimal morbidity, superior aesthetics, and improved health-related quality of life. 1–5 Breasts reconstructed with autologous tissues have the advantage over implants of a more natural appearance and feel resembling the native breast. Previous studies have reported fewer revi- sions and greater patient satisfaction with autolo- gous tissue breast reconstruction compared with implants. 6 The U.S. Nationwide Inpatient Sample Copyright © 2014 by the American Society of Plastic Surgeons DOI: 10.1097/PRS.0000000000000613 Toni Zhong, M.D., M.H.S. M. Ojha, M.N. Shaghayegh Bagher, M.Sc. Kate Butler, M.H.Sc. Coimbatore Srinivas, M.D. Stuart A. McCluskey, M.D., Ph.D. Hance Clarke, M.D., Ph.D. Anne C. O’Neill, M.D., Ph.D. Christine B. Novak, Ph.D. Stefan O. P. Hofer, M.D., Ph.D. Toronto, Ontario, Canada Background: The analgesic efficacy of the transversus abdominis plane periph- eral nerve block following abdominal tissue breast reconstruction has not been studied in a randomized controlled trial. Methods: The authors conducted a double-blind, placebo-controlled, 1:1 al- location, two-arm parallel group, superiority design, randomized controlled trial in patients undergoing microsurgical abdominally based breast recon- struction. Intraoperatively, epidural catheters were inserted under direct vision through the triangle of Petit on both sides of the abdomen into the transver- sus abdominis plane just before rectus fascial closure. Patients received either bupivacaine (study group) or saline (placebo group) through the catheters for 2 postoperative days. All patients received hydromorphone by means of a patient-controlled analgesic pump. The primary outcome was the difference in the parenteral opioid consumption on each postoperative day between the groups. The secondary outcome measures included the following: total in-hos- pital opioid; antinausea medication; pain, nausea, and sedation scores; Quality of Recovery Score; time to ambulation; and hospital stay duration. Results: Between September of 2011 and June of 2013, 93 patients were enrolled: 49 received bupivacaine and 44 received saline. There were 11 postoperative complications (13 percent); none were related to the catheter. Primary outcomes were completed by 85 of 93 patients (91.3 percent); the mean parenteral mor- phine consumption was significantly reduced on postoperative day 1 in the bu- pivacaine group (20.7 ± 20.1 mg) compared with 30.0 ± 19.1 mg in the control group (p = 0.02). There were no significant differences in secondary outcomes. Conclusion: Following abdominally based breast reconstruction, transversus abdominis plane peripheral nerve block is safe and significantly reduces mor- phine consumption in the early postoperative period. (Plast. Reconstr. Surg. 134: 870, 2014.) CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II. From the Divisions of Plastic and Reconstructive Surgery and Anesthesia and Pain Management, and the Adult Acute Pain Service, University Health Network; and the Division of Plastic and Reconstructive Surgery, University of Toronto. Received for publication March 20, 2014; accepted May 28, 2014. Transversus Abdominis Plane Block Reduces Morphine Consumption in the Early Postoperative Period following Microsurgical Abdominal Tissue Breast Reconstruction: A Double-Blind, Placebo-Controlled, Randomized Trial Outcomes Article This trial is registered under the name “TAP Block in DIEP or Free MS-TRAM Donor Site: A RCT,” ClinicalTrials.gov identification number NCT01398982 (http://clinicaltrials. gov/show/NCT01398982). Presented at the 59th Annual Meeting of the Plastic Surgery Research Council, in New York, New York, March 7 through 9, 2014, and awarded Session 2 Best Papers. BREAST