Pain control using Liposomal Bupivacaine vs Bupivacaine Pain Pump and a Control Group in Implant Based Breast Reconstruction Patients
Daniel R. Butz, MD1, Deana A. Shenaq, MD1, Brittany Kepler, Expected BS 20152, Veronica Rundell, PhD CCRP2, Jeff Thiel, PharmD, MS2, Glenn S. Murphy, MD2, Catherine Pesce, MD2, Mark Sisco, MD, FACS2, Michael A. Howard, MD2.
1University of Chicago Medicine, Chicago, IL, USA, 2NorthShore University HealthSystem, Chicago, IL, USA.
Purpose: Women undergoing mastectomy and prosthetic breast reconstruction have significant postsurgical pain, routinely mandating inpatient hospitalization. Liposomal bupivacaine, a new depot form of local anesthetic, may offer improved pain control in this setting. This study compares postoperative pain control, length of stay and complications using three different pain control methods in patients who underwent mastectomy and implant based reconstruction.
Methods: Three groups of 30 consecutive subjects receiving one of three postoperative pain control methods (liposomal bupivacaine, non-depot bupivacaine pain pump and narcotic medication alone) were created from a historical cohort of patients. A retrospective chart review of postoperative medication use, length of hospital stay and patient reported Visual Analog Scale (VAS) pain scores was performed.
Results: The average length of stay for the liposomal bupivacaine group was 1.5 days, 1.73 days (p=0.063) in the pain pump group and 2.00 (p=0.016) days in the control group. VAS pain scores were equivalent at 30 mins and 2 hours, whereas the liposomal bupivacaine group had significantly superior pain control at 4, 8, 12, and 16 hours compared to the pain pump and control group (p <0.01). While the liposomal bupivacaine group used markedly less narcotics, this did not reach statistical significance. There were no adverse events in the liposomal bupivacaine group.
Conclusions: Liposomal bupivacaine in prosthetic breast reconstruction patients was safe and effective, decreasing patient VAS pain scores, length of hospital stay and overall narcotic use.
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