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Comparison of Pain Experience Following Tissue Expander Breast Reconstruction Using Either Liposomal Bupivacaine or Silastic Bupivacaine Pain Pump
Morgan Brgoch, MD, Jason Muelleck, BS, Sanjib Adhikary, MD, John Potochny, MD.
Penn State Hershey Medical Center, Hershey, PA, USA.

PURPOSE:
A reported national crisis of opioid over-prescription and potential for abuse has prompted the need to identify effective non-opioid alternative analgesia following surgical procedures.
Liposomal bupivacaine (EXPAREL®) was recently introduced as an adjunct treatment modality for maintaining adequate post-operative analgesia. With its extended duration of action, proponents argue the potential for effective pain reduction while limiting the amount of opiates administered. In this study, we aim to determine the impact of EXPAREL® versus a silastic bupivacaine pain pump (BPP) on post-operative outcomes in patients who underwent bilateral complete mastectomies with tissue expander breast reconstruction (TEBR).
METHODS:
After IRB approval, we conducted a retrospective review of TEBRs performed at our tertiary care center between September 2012 and September 2015. In addition to patient demographics, data collected included: intra-operative fill volume, total opiate administration (IV morphine equivalent), subjective pain scores, as well as potential surgical site infection (SSI), wound dehiscence, seroma, or hematoma. The data was evaluated using t-test or chi-squared analysis as appropriate.
RESULTS:
88 patients met the study inclusion/exclusion criteria; EXPAREL® (n=41), BPP (n=47). Patients receiving EXPAREL® required significantly higher opiate administration than the BPP group (26.1mg vs 18.6mg p=.006) to achieve adequate analgesia (24-hours postoperative). No significant differences were found with respect to: intraoperative fill volume, patient pain scores, SSI, wound dehiscence, seroma, or hematoma.
CONCLUSION:
In comparison to BPP, patients who received EXPAREL® required significantly higher opiate administration following bilateral mastectomies and TEBR. Subjective pain scores and rates of post-operative complications did not differ between study groups.


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