Author of

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  P2.15 - Treatment in the Real World - Support, Survivorship, Systems Research (Not CME Accredited Session) (ID 964)

  • Event: WCLC 2018
  • Type: Poster Viewing in the Exhibit Hall
  • Track:
  • Presentations: 1
  • Moderators:
  • Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall

  • 27234

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    P2.15-12 - Exparel vs. Bupivicaine for Postoperative Analgesia After VATS Lung Resection: Results of a Randomized Control Trial (ID 13322)

    16:45 - 18:00  |  Author(s): Joby Chandy
    • Abstract
    • Slides

    Background
    

    Postoperative pain control practices are highly variable and opioid use is of considerable interest to clinicians and patients. This thoracic surgery program focuses on minimally invasive interventions and sought an optimal pain control regimen. Previously, tunneled pleural catheters with a continuous Bupivicaine infusion for 7 days were used. The shortened length of stay (LOS) and excellent patient satisfaction observed were attributed to this technique, however a prior randomized controlled trial (RCT) at this institution showed no differences in opioid use between catheters or singular injections of Bupivicaine. Exparel (Liposomal Bupivacaine formulation) reports local anesthesia up to 72 hours. Exparel’s emergence removed the catheter burden and compares local infiltration of Exparel with standard 0.25% Bupivacaine injections into the subcutaneous space.

    a9ded1e5ce5d75814730bb4caaf49419 Method
    

    This RCT compares both injections’ analgesic effects on opioid use. Adult VATS lung resection patients from 2015-2017 were eligible. Patients with: chronic opioid use, pain medication allergies, liver or renal dysfunction, severe COPD, peptic ulcerative disease, or pregnancy were excluded. The primary endpoint measured differences in opioid utilization in postoperative days (POD) 0-7, via chart review and self-reported pain medication use post-discharge. Hydromorphone equivalents were utilized for opioid conversions. Wilcoxon rank-sum and Fisher’s exact tests compared all appropriate endpoints.

    4c3880bb027f159e801041b1021e88e8 Result
    

    Sample sizes, opioid utilization, and pain scores are demonstrated in Table 1. No differences were observed for opioid utilization between groups for all PODs. No differences in pain scores (except for POD4), 30-day patient satisfaction (98% vs. 90% very satisfied), or LOS (0 [0-1] vs. 0 [0-1]) were observed.

    8eea62084ca7e541d918e823422bd82e Conclusion
    

    These results suggest clinical equipoise between Exparel and Bupivicaine and practitioners cannot justify routine use of Exparel in this patient population for improved postoperative pain control. Appropriate preoperative preparation and attention to proven evidence-based metrics designed to decrease morbidity, such as ambulation, should take precedence over a focus on pain management.

    6f8b794f3246b0c1e1780bb4d4d5dc53

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