A R Shah, MD, A Myers, MD, C M Lohse, A L McConico, P E Skaran, J Bingener, MD. Department of Surgery, Mayo Clinic, Rochester, MN.
Introduction: Postoperative pain frequently is highest on postoperative day one and has physiological, physical and mental consequences for a patient. Enhanced recovery pathways utilize multimodality pain regimen including local anesthetics. We hypothesized that patients who received a longer acting liposomal bupivacaine (EXPAREL®) after laparoscopic cholecystectomy within a standardized postoperative pain regimen experience less pain postoperative day #1 (POD 1), than those receiving regular bupivacaine.
Methods: This is a cohort analysis study of prospectively collected postoperative pain data of 37 patients undergoing laparoscopic cholecystectomy between May 2011 to August 2013. Liposomal bupivacaine was introduced into the patient care in November 2012. Pain scores were assessed with visual analog scale (VAS) pain score scales in PACU (postanesthesia care unit), POD 1, & POD 7. A pain regimen with Tylenol and NSAIDS (tramadol for patient who could not tolerate NSAIDS) was standardized. Comparative Kruskal-Wallis analysis was used for pain scores POD 1 on patients with liposomal bupivacaine vs. patients with regular bupivacaine.
Results: Thirty-seven patients underwent laparoscopic cholecystectomy. 24 women and 13 men, with mean age of 53 years and mean BMI of 31. Eight cholecystectomy patients received EXPAREL®. The overall VAS pain score for all patient in PACU was 2.65 (+ 3.4), on POD 1 was 4.4 (+ 3.08) and on POD 7 the score was 2.1 (+ 1.9) In the liposomal bupivacaine group, mean pain score on POD 1 was 3.50+/-2.51 and 4.72 +/-3.25 with regular anesthetic group (p=0.36). (See figure)
Conclusions: This small study did not show a significant pain difference on POD 1 between patients receiving EXPAREL® compared to regular bupivacaine for patients undergoing laparoscopic cholecystectomy. Given the large standard variation and small patient number, the question warrants future analysis with a larger patient population.