Intra-operative Use of Liposomal Bupivacaine and its Effect on Post-operative Pain in Breast Augmentation

Abstract

Introduction: Liposomal bupivacaine (Exparel©, Pacira Pharmaceuticals, Inc., Parsippany, NJ) is a local anesthetic, approved by the FDA for introduction into surgical sites for post-operative analgesia in October of 2011. Pharmaceutical advertisements claim that Exparel© relieves pain up to 72 hours, and that patients may require less pain medication during their recovery. Currently there is limited data with few non-industry funded, controlled studies concerning its efficacy. Methods: A single center, prospective open-label study was conducted over a year period comparing bupivacaine with epinephrine to liposomal bupivacaine, in regards to patient post-operative pain scores and narcotic usage on patients undergoing breast augmentation. All studied patients had breast augmentation with identical surgical technique. Studied patients had sub-muscularly placed saline implants performed by a single surgeon at one surgical facility. Results: Thirty-two patients of 40 successfully participated in the study (11 in the control group and 21 in the experimental group). Patients who received liposomal bupivacaine reported lower pain scores which was statistically significant at p=0.02, however patients who received liposomal bupivacaine required more narcotics at 72 hours than patients in the control group. Statistical analysis showed a trend that patients who received liposomal bupivacaine used less hydrocodone post-operatively (p=0.05). Conclusions: Patients who received liposomal bupivacaine reported improved pain scores compared to bupivacaine with epinephrine. The improved pain score was minimal, and did not translate into a significantly lower usage of narcotics post-operatively. Our data suggests that that liposomal bupivacaine only provides improved pain relief for 48 hours and not the advertised 72 hours. Keywords: Post-operative pain, Pain score, Non-industry funded.