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A comparison of liposomal bupivacaine and bupivacaine: A Prospective randomized Control Study on Implant-Based Breast Reconstruction Patients

Rafael Couto, MD; Eliana F R Duraes, MD, PhD; Karolina Mlyneck, MD; Stephanie Kortyka, Sagar Rambhia BA; Graham Schwarz, MD; Andrea Arnaud Moreira, MD; Risal Djohan, MD; Steven Bernard, MD; James Zins, MD; Raymond Isakov, MD
Cleveland Clinic Foundation

Presenter: Rafael A. Couto

I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting

Director Name: Steven Bernard

Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)

PURPOSE: Study the pain control efficacy of liposomal bupivacaine (Exparel) in implant-based breast reconstruction patients.

METHOD: A prospective, randomized, controlled pilot study was designed for patients undergoing unilateral immediate breast reconstruction with expanders. Subjects received liposomal bupivacaine or bupivacaine HCl using a standardized field block technique protocol. Groups were postoperatively studied in terms of amount post-operative opioid medication usage, pain interference on daily activities using a numeric scale, percentage of pain control using the rescue medication, and patient satisfaction with analgesia.

RESULTS: The study comprised of 50 patients: liposomal bupivicaine group (n=25) and bupivacaine HCl group (n=25). The average expander size (469.0ml ±129.5 vs 393.0ml±122.2) and volume expansion (220ml±145.7 vs 138.8ml±122.0) was greater in the liposomal bupivicaine group when compared to bupivicaine patients (p<0.05). Liposomal bupivicaine group reported a lower average pain score on postoperative day 1 (3.9±1.4 vs 4.5±1.4) than patients receiving bupivicaine (p=0.02). Furthermore, the experimental group (83.0%±18.0) reported a significantly higher percentage of pain relief with rescue medications on post-operative day 4 than the control (67.0%±27.0) (p=0.03). Lastly, average patient satisfaction rate was significantly higher in liposomal bupivicaine patients (4.5±0.5) when compared to the bupivicaine HCl (3.9±0.9).

CONCLUSION: Patients that received field block infiltration with liposomal bupivicaine reported: 1) lower average pain score on the first postoperative day; 2) higher percentage of pain relief with rescue medications postoperative day 4; and 3) higher patient satisfaction. To the best of our knowledge this is the largest prospective, randomized controlled study evaluating the efficacy of drug on this population.

Author Contact Information:
Rafael Couto
2630 Colchestr Rd
Cleveland Heights, OH

216-287-0742 (cell)

Ohio,Pennsylvania,West Virginia,Indiana,Kentucky,Pennsylvania American Society of Plastic Surgeons

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