Intercostal Nerve Blockade with Exparel® Results in Lower Opioid Usage during the First 24 Hours after Video-Assisted...

Area of Science:

• Anesthesiology and Pain Management
• Thoracic Surgery
• Pharmacology

Background:

• Liposomal bupivacaine (LipoB) offers extended local anesthesia, utilized across various surgical disciplines.
• Intercostal nerve blocks are crucial for managing postoperative pain following thoracic procedures.

Purpose of the Study:

• To evaluate the efficacy of intraoperative liposomal bupivacaine for intercostal nerve blocks after video-assisted thoracic surgery (VATS).
• To compare postoperative opioid consumption between patients receiving LipoB and standard bupivacaine for VATS intercostal nerve blocks.

Main Methods:

• Retrospective, single-center review of VATS patients from August 2012 to December 2014.
• Comparison of 21 patients receiving LipoB intercostal nerve blocks with 26 controls receiving standard bupivacaine.
• Quantification of opioid use in morphine equivalents at 6, 24, 48, and 72 hours postoperatively.

Main Results:

• Liposomal bupivacaine group showed significantly lower opioid use within the first 6 hours (15.62 vs 52.41 morphine equivalents, P=0.001) and the subsequent 18 hours (28.98 vs 65.17 morphine equivalents, P=0.01).
• No significant difference in opioid usage was observed after the initial 24 hours.
• Length of hospital stay did not differ between the LipoB and standard bupivacaine groups.

Conclusions:

• Intraoperative intercostal nerve blocks with liposomal bupivacaine significantly decrease postoperative opioid requirements in the initial 24 hours after VATS.
• The prolonged anesthetic effect of LipoB appears most beneficial in the early postoperative period for VATS patients.
• Further research may explore optimal timing and dosing for liposomal bupivacaine in thoracic surgery pain management.