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Liposomal Bupivacaine Versus Bupivacaine/Epinephrine For Postoperative Pain Management In Patients Undergoing VATS Wedge Resection
Salvatore Parascandola, Jessica Ibanez, Graham Keir, Jacqueline Anderson, M. Blair Marshall, Deanna Flynn, Michael Plankey, Candice Cody, Marc Margolis.
Georgetown University, Washington, DC, USA.

OBJECTIVE: There is limited data on the comparison of multivesicular liposomal bupivacaine (MVLB) and bupivacaine/epinephrine (BE) for the management of pain following thoracic surgery. The purpose of this research is to compare MVLB and BE for intercostal blocks related to analgesic use and length of stay following VATS Wedge Resection.
METHODS: An IRB approved retrospective study of patients undergoing VATS wedge resection from 2010 to 2015 was performed. We sub-selected patients who stayed longer than 24 hours. Primary outcome measurements were length of stay and postoperative analgesic use at 12 hour intervals from 24 to 72 hours.
RESULTS: We identified 821 patients who underwent VATS, of which 194 underwent VATS wedge resection. Patients were excluded who went home within 24 hours (n=46), had an incomplete medication administration record (n=30), or whose procedure converted to thoracotomy or transferred to the intensive care unit (n=5).In the remaining 113 patients, intercostal blocks were performed with MLVB in 62 patients and BE in 51 patients. A Wilcoxon signed-rank test evaluated differences in median postoperative analgesic use and length of stay. At every interval postoperatively, those who received MVLB consumed fewer analgesics than those who received BE, with a statistically significant difference 24 to 36 hours postoperatively (20.25 mg (IQR:12.5-39.0) vs 45.0 mg (IQR:22.5-81.0); p=0.0059) and 60 to 72 hours postoperatively (15.0 mg (IQR:12.0-30.0) vs 33.75 mg (IQR:30.0-52.5) ;p=0.0350). In patients who stayed longer than 72 hours, the median cumulative analgesic consumption in those who received MVLB was statistically significantly lower than those who received BE (120.0 mg (IQR:112.5-272.5) vs 296.5 mg(IQR:212.25-412.0) p= 0.0414). Median length of stay for the MVLB and BE groups were 45:05 hours(IQR: 36:49) and 44:29 hours (IQR: 27:03), respectively. There were no adverse events related to blocks performed with MLVB.
CONCLUSIONS: Thoracic surgery patients who have blocks performed with MVLB require less analgesics postoperatively. This may decrease complications related to poor pain control and decrease side effects related to narcotic use in our patient population.

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