• Kathirvel Subramaniam, Christopher M Sciortino, Michael L Boisen, Luca La Colla, Alec Dickson, Emma Nowakowski, Kelly Prangley, and Kristine M Ruppert.
• Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA. Electronic address: subramaniamk@upmc.edu.
• J. Cardiothorac. Vasc. Anesth. 2023 Jan 1; 37 (1): 424942-49.

ObjectivesPoor pain control after cardiac surgery can be associated with postoperative complications, longer recovery, and development of chronic pain. The authors hypothesized that adding liposomal bupivacaine (LB) to plain bupivacaine (PB) will provide better and long-lasting analgesia when used for wound infiltration in median sternotomy.Study DesignProspective, randomized, and double-blinded clinical trial.SettingSingle institution, tertiary care university hospital.ParticipantsAdult patients who underwent elective cardiac surgery through median sternotomy.InterventionsA single surgeon performed wound infiltration of LB plus PB or PB into the sternotomy wound, chest, and mediastinal tube sites.Measurements And Main ResultsPatients were followed up for 72 hours for pain scores, opioid consumption, and adverse events. Sixty patients completed the study for analysis (LB group [n = 29], PB group [n = 31]). Patient characteristics, procedural variables, and pain scores measured at specific intervals from 4 hours until 72 hours postoperatively did not reveal any significant differences between the groups. Mixed-model regression showed that the trend of mean pain scores at movement in the LB group was significantly (p = 0.01) lower compared with the PB group. Opioid consumption over 72 hours was not significantly different between the 2 groups (oral morphine equivalents; median [interquartile range], 139 [73, 212] mg in LB v 105 [54, 188] mg in PB, p = 0.29). Recovery characteristics and adverse events were comparable.ConclusionsLB added to PB for sternotomy wound infiltration during elective cardiac surgery did not significantly improve the quality of postoperative analgesia.Copyright © 2022 Elsevier Inc. All rights reserved.

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