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Liposomal Bupivacaine Injection in Nuss Procedure Allows Narcotic Avoidance and Improved Outcomes
Paul M Jeziorczak1,2, Riley S Frenette1,3, Charles J Aprahamian1,2
1OSF Healthcare-Children's Hospital of Illinois, Peoria, Illinois, USA.
Liposomal bupivacaine significantly reduces opioid use, total cost, and length of stay for patients undergoing the Nuss procedure for pectus excavatum. This enhances patient outcomes and offers substantial cost savings.
Area of Science:
- Pediatric Surgery
- Pain Management
- Pharmacology
Background:
- The Nuss procedure is a minimally invasive surgery for pectus excavatum.
- Opioid avoidance, cost reduction, and length of stay (LOS) remain areas for improvement.
- Liposomal bupivacaine (Exparel) may offer benefits in postoperative care.
Purpose of the Study:
- To evaluate the impact of liposomal bupivacaine on outcomes after the Nuss procedure.
- To compare postoperative metrics between patients receiving standard care versus liposomal bupivacaine.
Main Methods:
- Retrospective review of 19 patients undergoing Nuss procedure (October 2014 - December 2019).
- Comparison of a control group (standard care, n=9) and an interventional group (liposomal bupivacaine, n=10).
- Statistical analysis using nonparametric Wilcoxon rank-sum and chi-squared/Fisher's exact tests (P < .05).
Main Results:
- Liposomal bupivacaine group showed significantly lower total cost ($13,289 vs $60,746) and Morphine Milligram Equivalents (MME) (76.8 vs 282).
- Significant reduction in Epidural Catheter usage (0% vs 100%) and Foley catheter usage (20% vs 100%) in the liposomal bupivacaine group.
- Shorter Length of Stay (LOS) observed in the liposomal bupivacaine group (3.00 days vs 5.00 days).
Conclusions:
- Liposomal bupivacaine significantly impacts postoperative outcomes in Nuss procedures.
- Reduced opioid administration, epidural catheter use, and LOS are key benefits.
- Liposomal bupivacaine demonstrates potential for significant cost savings and improved patient recovery.
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