Liposomal Bupivacaine Versus Bupivacaine/Epinephrine Intercostal Nerve Block as Part of an Enhanced Recovery After Thoracic Surgery (ERATS) Care Pathway for Robotic Thoracic Surgery |
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| Authors: | Karishma Kodia Syed S. Razi Joy A. Stephens-McDonnough Joanne Szewczyk Nestor R. Villamizar Dao M. Nguyen |
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| Affiliation: | 2. Division of Thoracic Surgery, Memorial Healthcare System, South Broward, FL;2. Department of Medical Statistics, Osaka City University Graduate School of Medicine, Osaka, Japan;3. Department of Cardiac Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan;4. Department of Anesthesiology, National Cerebral and Cardiovascular Center, Osaka, Japan;2. Department of Neurosurgery, Cangzhou Central Hospital, Cangzhou, China;3. Department of Gerontology, Cangzhou Central Hospital, Cangzhou, China;2. Department of Anesthesiology and Perioperative Medicine, Albany Medical Center, Albany, NY;3. Department of Anesthesia, Critical Care and Pain Medicine, Veterans Affairs Boston Healthcare System, West Roxbury, MA;4. Tufts University School of Medicine, Boston, MA;2. Flechette Research Group, Paris, France;3. Antibody in Therapy and Pathology, Pasteur Institute, Paris, France;4. Biostatistics Research Branch, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD |
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| Abstract: | ObjectivesTo 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.DesignA retrospective analysis of a prospectively maintained database of patients undergoing robotic thoracoscopic procedures between September 1, 2018 and October 31, 2019 was conducted.SettingUniversity of Miami, single-institutional.ParticipantsPatients.InterventionsTwo 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 ResultsComparative 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.ConclusionsAs 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. |
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