American Association of Plastic Surgeons

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Comparing Liposomal Bupivacaine (Exparel®), Bupivacaine-soaked Gelfoam®, And On-q Ropivacaine For Alleviating Donor Site Pain Following Alveolar Bone Grafting
Sarah A. Layon, BS, Austin D. Williams, BS, Heather R. Burns, BA, Matthew J. Parham, MS, Laura A. Monson, MD, FAAP, Edward P. Buchanan, MD, FACS, FAAP;
Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA

PURPOSE: Alveolar bone grafting (ABG) harvests bone from the iliac crest, which can be associated with significant donor site pain. Local anesthetic is a useful adjunct for postoperative pain and may alleviate opioid requirements following surgery. Our study compares the efficacy of Exparel to commonly used prolonged local anesthetics in the pediatric setting, such as bupivacaine-soaked Gelfoam and ON-Q pump ropivacaine.
METHODS: 71 patients undergoing iliac crest bone harvest were included in the study. 37 patients underwent open iliac crest harvest with administration of 1.3% liposomal bupivacaine at the donor site, 17 patients receiving 10 mL of 0.25% bupivacaine soaked in Gelfoam placed in the defect of the iliac crest, and 17 patients receiving continuous ON-Q pump ropivacaine infusion at 6 mL/hr at the donor site. Intraoperative pain medication, breakthrough opioid usage, and opioids prescribed at discharge were recorded.
RESULTS: Intraoperative pain medication and pre-incisional local anesthetic amounts were comparable between cohorts. Compared to bupivacaine soaked Gelfoam, Exparel had significantly reduced breakthrough opioid use within the first 24 hours (p < 0.001) and opioids prescribed at discharge (p = 0.008). When compared to ON-Q ropivacaine, Exparel also displayed significant reduction in opioid use in the first 24 hours (p < 0.001) and opioids prescribed at discharge (p = 0.027). No differences were noted between bupivacaine-soaked Gelfoam® and ON-Q ropivacaine groups.
CONCLUSION: This study suggests Exparel may have superior outcomes for postoperative pain control, and resultant decreased opioid consumption, compared to alternatives in patients undergoing iliac crest harvest for ABG.
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