Wayne B Bauerle, Sean Hamlin, Sean Dubois, Jameson M Petrochko, Zachary A Frenzel, Anna Ng-Pellegrino, William R Burfeind, Meredith A Harrison
{"title":"脂质体布比卡因对肺切除手术后恢复的影响","authors":"Wayne B Bauerle, Sean Hamlin, Sean Dubois, Jameson M Petrochko, Zachary A Frenzel, Anna Ng-Pellegrino, William R Burfeind, Meredith A Harrison","doi":"10.1016/j.athoracsur.2024.05.015","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>There is limited data showing the benefit of liposomal bupivacaine as part of an Enhanced Recovery After Surgery (ERAS) protocol in reducing opioid use in minimally invasive lobectomies.</p><p><strong>Methods: </strong>A retrospective observational study compared 3 cohorts of patients who underwent lobectomies between January 2015 and December 2021. The control group neither received liposomal bupivacaine intraoperatively nor underwent an ERAS protocol. The liposomal bupivacaine cohort only received a nerve block, whereas the ERAS cohort received a nerve block intraoperatively and underwent an ERAS protocol. The primary outcome was postoperative opioid consumption.</p><p><strong>Results: </strong>The study included 433 patients, comprising 87 in the control group, 138 in the liposomal bupivacaine alone cohort, and 208 in the ERAS/liposomal bupivacaine cohort. There was a statistically significant difference in the amount of opioids used between the control (43 oral morphine equivalents [OME]) and liposomal bupivacaine alone cohort (30.5 OME; P < .001), between control vs the ERAS/liposomal bupivacaine cohort (17 OME; P < .001), and between the liposomal bupivacaine alone and ERAS/liposomal bupivacaine cohorts (P < .001). Hospital stay was not statistically different between the 2 groups of interest (3 days); however, hospital stay differed from the control (4 days). Readmission at 30 days was not significantly different between the 3 groups (P = .43).</p><p><strong>Conclusions: </strong>Liposomal bupivacaine alone as part of a larger ERAS protocol significantly reduced opioid use and hospitalization duration; however, the reduction in opioid use was much greater with incorporation of liposomal bupivacaine into an ERAS protocol rather than in isolation. Prospective studies are needed to determine reproducibility and applicability of liposomal bupivacaine for opioid use reduction in other United States hospital systems.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":"219-226"},"PeriodicalIF":3.6000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Impact of Liposomal Bupivacaine on Enhanced Recovery After Surgery Protocol for Lung Resection.\",\"authors\":\"Wayne B Bauerle, Sean Hamlin, Sean Dubois, Jameson M Petrochko, Zachary A Frenzel, Anna Ng-Pellegrino, William R Burfeind, Meredith A Harrison\",\"doi\":\"10.1016/j.athoracsur.2024.05.015\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>There is limited data showing the benefit of liposomal bupivacaine as part of an Enhanced Recovery After Surgery (ERAS) protocol in reducing opioid use in minimally invasive lobectomies.</p><p><strong>Methods: </strong>A retrospective observational study compared 3 cohorts of patients who underwent lobectomies between January 2015 and December 2021. The control group neither received liposomal bupivacaine intraoperatively nor underwent an ERAS protocol. The liposomal bupivacaine cohort only received a nerve block, whereas the ERAS cohort received a nerve block intraoperatively and underwent an ERAS protocol. The primary outcome was postoperative opioid consumption.</p><p><strong>Results: </strong>The study included 433 patients, comprising 87 in the control group, 138 in the liposomal bupivacaine alone cohort, and 208 in the ERAS/liposomal bupivacaine cohort. There was a statistically significant difference in the amount of opioids used between the control (43 oral morphine equivalents [OME]) and liposomal bupivacaine alone cohort (30.5 OME; P < .001), between control vs the ERAS/liposomal bupivacaine cohort (17 OME; P < .001), and between the liposomal bupivacaine alone and ERAS/liposomal bupivacaine cohorts (P < .001). Hospital stay was not statistically different between the 2 groups of interest (3 days); however, hospital stay differed from the control (4 days). Readmission at 30 days was not significantly different between the 3 groups (P = .43).</p><p><strong>Conclusions: </strong>Liposomal bupivacaine alone as part of a larger ERAS protocol significantly reduced opioid use and hospitalization duration; however, the reduction in opioid use was much greater with incorporation of liposomal bupivacaine into an ERAS protocol rather than in isolation. Prospective studies are needed to determine reproducibility and applicability of liposomal bupivacaine for opioid use reduction in other United States hospital systems.</p>\",\"PeriodicalId\":50976,\"journal\":{\"name\":\"Annals of Thoracic Surgery\",\"volume\":\" \",\"pages\":\"219-226\"},\"PeriodicalIF\":3.6000,\"publicationDate\":\"2025-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Annals of Thoracic Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.athoracsur.2024.05.015\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/5/28 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Thoracic Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.athoracsur.2024.05.015","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/5/28 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Impact of Liposomal Bupivacaine on Enhanced Recovery After Surgery Protocol for Lung Resection.
Background: There is limited data showing the benefit of liposomal bupivacaine as part of an Enhanced Recovery After Surgery (ERAS) protocol in reducing opioid use in minimally invasive lobectomies.
Methods: A retrospective observational study compared 3 cohorts of patients who underwent lobectomies between January 2015 and December 2021. The control group neither received liposomal bupivacaine intraoperatively nor underwent an ERAS protocol. The liposomal bupivacaine cohort only received a nerve block, whereas the ERAS cohort received a nerve block intraoperatively and underwent an ERAS protocol. The primary outcome was postoperative opioid consumption.
Results: The study included 433 patients, comprising 87 in the control group, 138 in the liposomal bupivacaine alone cohort, and 208 in the ERAS/liposomal bupivacaine cohort. There was a statistically significant difference in the amount of opioids used between the control (43 oral morphine equivalents [OME]) and liposomal bupivacaine alone cohort (30.5 OME; P < .001), between control vs the ERAS/liposomal bupivacaine cohort (17 OME; P < .001), and between the liposomal bupivacaine alone and ERAS/liposomal bupivacaine cohorts (P < .001). Hospital stay was not statistically different between the 2 groups of interest (3 days); however, hospital stay differed from the control (4 days). Readmission at 30 days was not significantly different between the 3 groups (P = .43).
Conclusions: Liposomal bupivacaine alone as part of a larger ERAS protocol significantly reduced opioid use and hospitalization duration; however, the reduction in opioid use was much greater with incorporation of liposomal bupivacaine into an ERAS protocol rather than in isolation. Prospective studies are needed to determine reproducibility and applicability of liposomal bupivacaine for opioid use reduction in other United States hospital systems.
期刊介绍:
The mission of The Annals of Thoracic Surgery is to promote scholarship in cardiothoracic surgery patient care, clinical practice, research, education, and policy. As the official journal of two of the largest American associations in its specialty, this leading monthly enjoys outstanding editorial leadership and maintains rigorous selection standards.
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