Advertisement

Liposomal Bupivacaine Versus Bupivacaine/Epinephrine Intercostal Nerve Block as Part of an Enhanced Recovery After Thoracic Surgery (ERATS) Care Pathway for Robotic Thoracic Surgery

Published:March 04, 2021DOI:https://doi.org/10.1053/j.jvca.2021.02.065

      Abstract

      Objectives

      To examine how postoperative pain control after robotic thoracoscopic surgery varies with liposomal bupivacaine (LipoB) versus 0.5% bupivacaine/1:200,000 epinephrine (Bupi/Epi) intercostal nerve blocks within the context of an enhanced recovery after thoracic surgery (ERATS) protocol.

      Design

      A retrospective analysis of a prospectively maintained database of patients undergoing robotic thoracoscopic procedures between September 1, 2018 and October 31, 2019 was conducted.

      Setting

      University of Miami, single-institutional.

      Participants

      Patients.

      Interventions

      Two hundred fifty-two patients had either LipoB intercostal nerve blocks (n = 129) or Bupi/Epi intercostal nerve blocks (n = 123) when undergoing robotic thoracic surgery.

      Measurements and Main Results

      Comparative analysis of patient-reported pain levels, in-hospital and post-discharge opioid requirements, 90-day operative complications, length of hospital stay, and hospital costs was performed. Data were stratified to either anatomic lung resection or pulmonary wedge resection/mediastinal-pleural procedures. Bupi/Epi patients reported significantly more acute postoperative pain than LipoB patients, which correlated with higher in-hospital and post-discharge opioid requirements. There were no differences in postoperative complications, length of hospital stay, or hospital costs between the two groups.

      Conclusions

      As part of an ERATS protocol, infiltration of intercostal spaces and surgical wounds with LipoB for robotic thoracoscopic procedures afforded better postoperative subjective pain control and decreased opioid requirements without an increase in hospital costs as compared with use of Bupi/Epi.

      Graphical Abstract

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Cardiothoracic and Vascular Anesthesia
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Servais EL
        • Towe CW
        • Brown LM
        • et al.
        The Society of Thoracic Surgeons General Thoracic Surgery Database: 2020 Update on Outcomes and Research.
        Ann Thorac Surg. 2020; 110: 768-775
        • Broderick SR
        • Grau-Sepulveda M
        • Kosinski AS
        • et al.
        The Society of Thoracic Surgeons composite score rating for pulmonary resection for lung cancer.
        Ann Thorac Surg. 2020; 109: 848-855
        • Madani A
        • Fiore Jr, JF
        • Wang Y
        • et al.
        An enhanced recovery pathway reduces duration of stay and complications after open pulmonary lobectomy.
        Surgery. 2015; 158: 899-910
        • Martin LW
        • Sarosiek BM
        • Harrison MA
        • et al.
        Implementing a thoracic enhanced recovery program: Lessons learned in the first year.
        Ann Thorac Surg. 2018; 105: 1597-1604
        • Van Haren RM
        • Mehran RJ
        • Mena GE
        • et al.
        Enhanced recovery decreases pulmonary and cardiac complications after thoracotomy for lung cancer.
        Ann Thorac Surg. 2018; 106: 272-279
        • Razi SS
        • Stephens-McDonnough JA
        • Haq S
        • et al.
        Significant reduction of postoperative pain and opioid analgesics requirement with an enhanced recovery after thoracic surgery protocol [e-pub ahead of print].
        J Thorac Cardiovasc Surg. 2020; (Accessed March 15, 2021)https://doi.org/10.1016/j.jtcvs.2019.12.137
        • Krebs ED
        • Mehaffey JH
        • Sarosiek BM
        • et al.
        Is less really more? Reexamining video-assisted thoracoscopic versus open lobectomy in the setting of an enhanced recovery protocol.
        J Thorac Cardiovasc Surg. 2020; 159 (284-94.e281)
        • Nelson DB
        • Mehran RJ
        • Mitchell KG
        • et al.
        Enhanced recovery after thoracic surgery is associated with improved adjuvant chemotherapy completion for non–small cell lung cancer.
        J Thorac Cardiovasc Surg. 2019; 158 (279-86.e271)
        • Johnson MD
        • Mickler T
        • Arthur GR
        • et al.
        Bupivacaine with and without epinephrine for intercostal nerve block.
        J Cardiothorac Anesth. 1990; 4: 200-203
        • Dominguez DA
        • Ely S
        • Bach C
        • et al.
        Impact of intercostal nerve blocks using liposomal versus standard bupivacaine on length of stay in minimally invasive thoracic surgery patients.
        J Thorac Dis. 2018; 10: 6873
        • Rincavage M
        • Hammond L
        • Reddy S
        • et al.
        Pain control using liposomal bupivacaine versus bupivacaine for robotic assisted thoracic surgery.
        Int J Clin Pharm. 2019; 41: 258-263
        • Parascandola SA
        • Ibañez J
        • Keir G
        • et al.
        Liposomal bupivacaine versus bupivacaine/epinephrine after video-assisted thoracoscopic wedge resection.
        Interact Cardiovasc Thorac Surg. 2017; 24: 925-930
        • Kelley TM
        • Bailey DW
        • Sparks P
        • et al.
        Intercostal nerve blockade with exparel results in lower opioid usage during the first 24 hours after video-assisted thorascopic surgery.
        Am Surg. 2018; 84: 1433-1438
        • Weksler B
        • Sullivan JL
        • Schumacher LY.
        Randomized trial of bupivacaine with epinephrine versus bupivacaine liposome suspension in patients undergoing minimally invasive lung resection [e-pub ahead of print].
        J Thorac Cardiovasc Surg. 2020; (Accessed March 15, 2021)https://doi.org/10.1016/j.jtcvs.2020.01.112
        • Von Elm E
        • Altman DG
        • Egger M
        • et al.
        The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies.
        Ann Intern Med. 2007; 147: 573-577
        • Dindo D
        • Demartines N
        • Clavien P-A.
        Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey.
        Ann Surg. 2004; 240: 205
        • Soneji N
        • Clarke HA
        • Ko DT
        • et al.
        Risks of developing persistent opioid use after major surgery.
        JAMA Surg. 2016; 151: 1083-1084
        • Brescia AA
        • Harrington CA
        • Mazurek AA
        • et al.
        Factors associated with new persistent opioid usage after lung resection.
        Annals Thorac Surg. 2019; 107: 363-368
        • Bartels K
        • Mayes LM
        • Dingmann C
        • et al.
        Opioid use and storage patterns by patients after hospital discharge following surgery.
        PloS One. 2016; 11e0147972
        • Bicket MC
        • Long JJ
        • Pronovost PJ
        • Alexander GC
        • Wu CL.
        Prescription opioid analgesics commonly unused after surgery: A systematic review.
        JAMA Surg. 2017; 152: 1066-1071
        • Nelson DB
        • Cata JP
        • Niu J
        • et al.
        Persistent opioid use is associated with worse survival after lobectomy for stage I non-small cell lung cancer.
        Pain. 2019; 160: 2365-2373
        • Louis SG
        • King C
        • Baral P
        • Veeramachaneni N.
        Liposomal bupivacaine enhances the pain-control benefits of uniportal thoracoscopic lobectomy.
        Ann Thorac Surg. 2019; 108: 1514-1518
        • Yang Z
        • Zhao L
        • Li S
        • et al.
        Is liposomal bupivacaine superior to standard bupivacaine for pain control following minimally invasive thoracic surgery?.
        Interact Cardiovasc Thorac Surg. 2020; 31: 199-203
        • Pedoto A
        • Noel J
        • Park BJ
        • et al.
        Liposomal bupivacaine versus bupivacaine hydrochloride for intercostal nerve blockade in minimally invasive thoracic surgery [e-pub ahead of print].
        J Cardiothorac Vasc Anesth. 2020; (Accesed March 15, 2021)https://doi.org/10.1053/j.jvca.2020.11.067
        • Campos JH
        • Seering M
        • Peacher D.
        Is the role of liposomal bupivacaine the future of analgesia for thoracic surgery? An update and review.
        J Cardiothorac Vasc Anesth. 2020; 34: 3093-3103
        • Manson WC
        • Blank RS
        • Martin LW
        • et al.
        An observational study of the pharmacokinetics of surgeon-performed intercostal nerve blockade with liposomal bupivacaine for posterior-lateral thoracotomy analgesia.
        Anesth Analg. 2020; 131: 1843-1849

      Linked Article