Bailey Buenger, PharmD
Nebraska Medicine - Nebraska Medical Center
Omaha, NE
Disclosure information not submitted.
Gregory Peitz, PharmD, BCCCP, FCCM
Clinical Associate Professor and Critical Care Coordinator
Nebraska Medicine
Omaha, Nebraska, United States
Disclosure information not submitted.
Title: Evaluation of Liposomal Bupivacaine in Cardiothoracic Surgery Patients Requiring Sternotomy
Introduction: Inadequate post-operative pain control is associated with negative consequences. There is growing evidence to use opioid-sparing strategies to address post-operative pain with one option being the use of infiltrated liposomal bupivacaine (LB). The goal of this study was to evaluate if LB reduced the amount of opioids required following cardiothoracic surgery compared to conventional pain management (CPM).
Methods: A retrospective matched cohort study compared cardiothoracic surgery patients from December 2016 to August 2020 who received LB to those who received CPM post-operatively. Patients were matched on demographics including age, sex, and Medicare severity diagnosis related groups (MS-DRG). The primary outcome was the total opioid use at 72-hours post-operation which was quantified using morphine milligram equivalents (MME). Additional outcomes included post-operative pain scores, length of mechanical ventilation (MV), concurrent sedation requirements, cost of pain and sedation medications, post-operative ICU and hospital lengths of stay (LOS) and opioid prescriptions at discharge. Comparative analysis of outcomes between the two cohorts was performed using SPSS.
Results: After matching, 120 patients were included in the study analysis with 60 in each cohort. There was no difference in median [IQR] total opioid use in the first 72-hours post-operation between patients receiving LB or CPM (113mg [55,198] vs 105mg [51,178], p=0.57). There were no significant differences in additional secondary outcomes including post-operative pain scores, concurrent sedation requirements, or concurrent non-opioid analgesic use. Those individuals receiving LB had significantly higher costs of pain and sedation medications than those receiving CPM ($494 [473,530] vs $101 [31,153], p< 0.001) but had a reduced length of MV (1.08±0.6 vs 1.33±0.06 days, p=0.015). No differences were observed between LB and CPM in regard to ICU LOS (2 [1,4] vs 2 [1,3], p=0.78), hospital LOS (6 [5,10] vs 6 [5,9], p=0.92) or incidence of opioid prescription at discharge (52 [87%] vs 43 [72%], p=0.071).
Conclusions: Liposomal bupivacaine was not observed to have an opioid-sparing effect following cardiothoracic surgery. Larger studies are needed to determine the role of liposomal bupivacaine in the cardiothoracic surgery patient population.