Category: Federal Forum Posters
Purpose: Pain management is a significant component of postoperative recovery. A multimodal analgesic regimen is a main element of Enhanced Recovery After Surgery, which aims to optimize postoperative analgesia while minimizing opioid-related side effects. The efficacy of local anesthetics is limited by a short duration of action. Liposomal bupivacaine is a sustained-release formulation used as part of a postoperative multimodal approach to pain control with the goal of providing a longer duration of analgesia. This project was designed to evaluate opioid use and hospital length of stay following the use of liposomal bupivacaine in comparison to standard bupivacaine.
Methods: In this retrospective quality improvement study, patients administered liposomal bupivacaine from July 1, 2018 to December 31, 2018 were matched to a cohort of patients administered standard bupivacaine for comparable surgical procedures from July 1, 2017 to December 31, 2017. Matching was based on age, gender, race, and BMI. Data was collected from transaction reports generated from Automated Dispensing Cabinets specific to anesthesia, and from electronic medical records via chart review. Patients were excluded if they had an active outpatient opioid prescription within 30 days prior to surgery, cases that were converted to open intraoperatively, missing data for time of medication administration, and procedures that could not be matched to those seen in the standard bupivacaine group. The primary objectives were to assess the utilization of liposomal bupivacaine at VA Long Beach and to evaluate opioid use and hospital length of stay in comparison to standard bupivacaine. The secondary objectives compared the time to first opioid, quantity of opioids prescribed at discharge, number of patients prescribed additional opioids within 30 days of discharge, number of pain-related emergency department visits or readmissions within 30 days of discharge, and quantity of additional pain medications used. Statistical analysis was performed using Fisher’s exact, T-test, and Mann-Whitney test where appropriate.
Results: Of the 81 patients with record of liposomal bupivacaine removal from the Automated Dispensing Cabinet, 62 had documentation of medication administration. After exclusion, 47 patients were matched to the standard bupivacaine group. Opioid consumption, measured in milligram morphine equivalents, was significantly less in the liposomal bupivacaine group at each time point of 0-24 hours post-surgery (21.9 vs. 60.2, p=0.006), 24-48 hours (7 vs. 16.6, p=0.039), and total duration of hospitalization (35.8 vs. 88, p=0.004). There was no difference in length of stay (2.21 days vs. 2.23 days, p=0.48). There were no significant differences in time to first opioid (3 hours vs. 2 hours, p=0.17), quantity of opioids prescribed at discharge (84 vs. 95.7, p=0.23), number of patients prescribed additional opioids (4 vs. 8, p=0.18), and number of pain-related emergency department visits or readmissions (4 vs. 5, p=0.72). Patients in the liposomal bupivacaine group used a significantly greater quantity of gabapentin.
Conclusion: Data showed a significant reduction in opioid use in the liposomal bupivacaine group compared to the standard bupivacaine group, with no difference in length of stay. There was a trend towards a longer time to first opioid, reduced quantity of opioids prescribed at discharge, and less patients prescribed additional opioids at follow-up in the liposomal bupivacaine group. Similarities in the quantity of additional analgesic use between groups may suggest better pain control with liposomal bupivacaine. Compared with standard bupivacaine, liposomal bupivacaine reduced postsurgical opioid consumption but did not reduce length of stay.