The Safety of Perioperative Liposomal Bupivacaine Injections in Dermatologic Surgery Patients

There is a paucity of literature investigating the use of liposomal bupivacaine (LB) in a dermatologic surgery setting.

To identify the treatment characteristics and adverse events, including Local Anesthetic System Toxicity (LAST), in patients receiving perioperative LB.

A retrospective chart review was performed at a single institution using an institutional database and key words "Exparel" or "liposomal bupivacaine." Patients ≥18 years old who received perioperative LB to the surgical site and surrounding skin were included.

A total of 140 LB administrations and 129 patients were included. Liposomal bupivacaine was used most often in the setting of excisions ( n = 88, 62.9%) and Mohs micrographic surgery ( n = 49, 35%), with hidradenitis suppurativa ( n = 77, 55%) and cutaneous neoplasms ( n = 56, 40%) the most frequent diagnoses. The median postoperative area and length were 23.6 cm 2 and 15.4 cm, respectively. The median LB dosage was 20 mL (range 1.5-20). There were no adverse events in 134 out of 136 patients of LB administration (98.5%). There were 2 reports (1.5%) of nausea on POD1 while these patients were taking opioids.

Liposomal bupivacaine should be considered for postoperative analgesia in patients undergoing dermatologic surgery because it is well tolerated and efficacious. The authors observed no cases of LAST.