• Donn A Marciniak, Andrej Alfirevic, Ryan M Hijazi, Daniel J Ramos, Andra E Duncan, A Marc Gillinov, Usman Ahmad, Sudish C Murthy, and Daniel P Raymond.
• Department of Cardiothoracic Anesthesia, Cleveland Clinic, Cleveland, OH. Electronic address: marcind@ccf.org.
• J. Cardiothorac. Vasc. Anesth. 2021 May 1; 35 (5): 1404-1409.

ObjectiveAssess the efficacy of adding liposomal bupivacaine (LB) to bupivacaine-containing intercostal nerve blocks (ICNBs) to improve analgesia and decrease opioid consumption and hospital length of stay compared with bupivacaine-only ICNBs.DesignThis retrospective, observational investigation compared pain intensity scores and cumulative opioid consumption within the first 72 postoperative hours in patients who received ICNBs with bupivacaine plus LB (LB group) versus bupivacaine only (control group) after minimally invasive anatomic pulmonary resection. LB was tested for noninferiority on pain scores and opioid consumption. If LB was noninferior, superiority of LB was tested on both outcomes.SettingAcademic tertiary care medical center.ParticipantsAdult patients undergoing minimally invasive anatomic pulmonary resection.InterventionsNone.Measurements And Main ResultsFor the secondary analysis, hospital length of stay was compared through the Cox regression model. Of 396 patients, 178 (45%) received LB and 218 (55%) did not. The mean (standard deviation) pain score was three (one) in the LB group and three (one) in the control group, with a difference of -0.10 (97.5% confidence interval [-0.39 to 0.18]; p = 0.41). The mean (standard deviation) cumulative opioid consumption (intravenous morphine equivalents) was 198 (208) mg in the LB group and 195 (162) mg in the control group. Treatment effect in opioid consumption was estimated at a ratio of geometric mean of 0.94 (97.5% confidence interval [0.74-1.20]; p = 0.56). Pain control and opioid consumption were noninferior with LB but not superior. Hospital discharge was not different between groups.ConclusionsLB with bupivacaine in ICNBs did not demonstrate superior postoperative analgesia or affect the rate of hospital discharge.Copyright © 2020 Elsevier Inc. All rights reserved.

16 keywords...

hide…