Exparel versus the On-Q Pump: A Head to Head Comparison in Breast Reconstruction
Michael G. Tecce, D.O., Alison Bae, B.S., Olatomide T. Familusi, M.D., Michael A. Lanni, B.S., Jason M. Weissler, M.D., Martin J. Carney, B.S., Joseph M. Serletti, M.D., Joshua Fosnot, M.D..
University of Pennsylvania, Philadelphia, PA, USA.
PURPOSE: Patients undergoing autologous breast reconstruction experience significant abdominal wall morbidity. This study aims to compare the use of Exparel (liposomal bupivacaine) with the On-Q pump catheter (bupivacaine) for pain control following autologous breast reconstruction.
METHODS: Patients who underwent Exparel injection and On-Q implantation following autologous reconstruction were reviewed. Primary outcome measures included: Patient Controlled Analgesia (PCA) dose/frequency/attempts/rejections, daily pain score, required oral postoperative pain medication, and return-to-ambulation. Postoperative oral pain medications were converted to morphine equivalent dosages for analysis. Pain scores were on a 010 scale and return-to-ambulation was calculated using the Braden scale. Bivariate statistics were performed to identify differences and similarities between the two groups.
RESULTS: 80 patients were reviewed; 40 received Exparel intraoperatively and 40 received the On-Q pump. Patients using the On-Q pump required significantly higher total doses from the PCA (p<0.001). There was no significant difference in return-to-ambulation on postoperative day 0,2,3,or 4, though patients using OnQ had a higher level of ambulation on postoperative day 1 (p=.033). There was no significant difference in pain scores on postoperative day 1, however, patients using On-Q required higher total doses of PCA for analgesia (p=0.008). For POD 2-5, the Exparel group reported higher pain scores, but required less medication to control their pain (p<0.001).
CONCLUSION: Patients receiving Exparel require less doses of opioids on POD1, while no discernible difference is observed in the amount of oral pain medication between the two groups. The maximum benefit of Exparel is realized primarily in the first 24-48 postoperative hours.
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