Lindsay J. Nitsche BS , Paul J. Devlin MD, MSc , Sarah J. Bond MS, PA-C , Jeremy A. Friedman MD , Kaitlyn R. Rubnitz PA-C , Emily Schwartz MSN, CRNP , Colleen E. Bontrager BA , Lauren I. Karel PharmD , Susan C. Nicolson MD , Stephanie M. Fuller MD, MS
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Abstract
Objective
Bupivacaine liposomal injectable suspension is proven safe and effective for selective postsurgical analgesia in children older than 6 years. We evaluated if intraoperative bupivacaine liposomal injectable suspension administration decreases postoperative opioid use, peak pain scores, and length of stay in children aged 2 to 6 years undergoing cardiac surgery via median sternotomy.
Methods
Serial patients aged 2 to 6 years undergoing cardiac surgery received 4 mg/kg bupivacaine liposomal injectable suspension mixed with 0.25% bupivacaine hydrochloride and 0.9% sodium chloride via local infiltration at the conclusion of their procedure. They were matched with controls who underwent operation within the past 5 years by procedure, age, gender, and weight. Postoperative opioid use was converted into morphine milligram equivalents, and pain severity was measured using the Face, Legs, Activity, Cry, and Consolability scale. Paired t tests, chi-square tests, and descriptive statistics were used depending on the nature of the data.
Results
A total of 100 patients receiving bupivacaine liposomal injectable suspension and matching historical control patients aged 2 to 6 years were analyzed. There were no significant differences in preoperative variables. Patients receiving bupivacaine liposomal injectable suspension received an average of 3.6 (95% CI, 1.2-6.0) fewer morphine milligram equivalents (P = .003). However, there was no significant difference in peak pain score (P = .4), time to first enteral intake (P = .5), intensive care unit length of stay (P = 1), or hospital length of stay (P = .2). The median cost of bupivacaine liposomal injectable suspension was higher than that of bupivacaine hydrochloride (P < .001).
Conclusions
Intraoperative bupivacaine liposomal injectable suspension use in children aged 2 to 6 years undergoing cardiac surgery showed statistically but not clinically significant decreases in postoperative opioid use. Bupivacaine liposomal injectable suspension use had no impact on intensive care unit or hospital length of stay but was substantially more expensive.
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