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The Use of Liposomal Bupivacaine in Patients Undergoing Abdominally-Based Autologous and Implant-Based Breast Reconstruction
Gina Farias-Eisner, MD1, Ivy Kwon, MPH1, Alfred Yoon, MD2, Michael Delong, MD1, Andrew Gassman, MD3, Siamak Rahman, MD1, Christopher Crisera, MD1, Andrew Da Lio, MD1, Jason Roostaeian, MD1, Charles Tseng, MD1, Jaco Festekjian, MD1.
1University of California, Los Angeles, Los Angeles, CA, USA, 2University of Michigan, Ann Arbor, MI, USA, 3Temple University, Philadelphia, PA, USA.

PURPOSE: Federal mandates to reduce opioid use have placed analgesia management in the national conversation. Liposomal bupivacaine (LB) is an effective analgesic in the immediate postoperative period. This study explores the effect of LB on postoperative narcotic use, length of stay (LOS), and patient satisfaction in women undergoing autologous and implant-based breast reconstruction.
METHODS: In our previous study, patients undergoing autologous (n=37) and implant-based reconstruction (n=20) who were injected with LB demonstrated significantly decreased total and oral narcotic use compared to controls. We subsequently changed our post-operative protocol and examined these changes over a 90-day implementation period. Patients undergoing abdominally-based autologous reconstruction (n=9) were transitioned to oral narcotics on post-operative day (POD) 2 rather than POD 3. Patient controlled analgesia (PCA) was eliminated from post-operative protocol in patients undergoing implant-based reconstruction (n=16). These patients were discharged on POD 1 rather than POD 2. Both patient groups were injected with LB and compared to historic controls. We examined LOS and patient satisfaction as primary outcomes within these populations.
RESULTS: Patients undergoing implant-based reconstruction, subjected to the new protocol, demonstrated a decreased length of stay. Utilizing standardized surveys, improvements in pain control were demonstrated with a percentile ranking change from 88th to 99th percentile, pain management summary score improvement from 62nd to 99th percentile, and improvement in pain control ranking from 27th to 99th percentile.
CONCLUSION: This study demonstrates patients undergoing implant and autologous-based breast reconstruction, who receive regional block with LB, use significantly fewer narcotics with decreased LOS and improved satisfaction.


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