Author of

• 20180

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  P2.16 - Surgery (ID 717)

  • Event: WCLC 2017
  • Type: Poster Session with Presenters Present
  • Track: Surgery
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)

  • 23532

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    P2.16-001 - Liposomal Bupivacaine (Exparel) Reduces Thoracic Surgery Post-Operative Pain  and Reduces Length of Stay, a Retrospetive Study (ID 7351)

    09:30 - 09:30  |  Author(s): R. Jongco
    • Abstract

    Background:
    Intercostal nerve blocks with a liposomal Marcaine formulation (Exparel) was reported to provide pain relief equivalent to an epidural in the immediate post operative period following a thoracotomy. We compared pain relief of thoracotomies that received an Exparel block to minimally invasive procedures in the immediate and extended post-operative period.
    
    Method:
    We reviewed the records of 166 patients who underwent thoracic surgery procedures with a thoracotomy or a video-assisted thoracoscopic surgery (VATS) and who received multilevel paravertebral nerve blocks with either Exparel or 1 % Marcaine with epinephrine. Pain scores and opiate use were routinely recorded by nurses for the first 48 hours as well as opiate use in the postoperative days (POD) 5 to 13 (by patients). Clinical variables, atrial fibrillation, pulmonary complications, and hospital length of stay (LOS) were also examined. Statistics included t-test for means, and Fisher exact for proportions.
    
    Result:
    Fifty patients underwent a VATS wedge resection with a paravertebral block with Exparel (VATS-E) and 53 patients underwent a VATS wedge resection with a paravertebral block with Marcaine (VATS-M). The pain score were lower for the VATS-E vs. the VATS-M patients (p< 0.001). 32 patients underwent a thoracotomy with an Exparel block (Thor-E) (30 lobectomies) and 15 patients had a VATS lobectomy with a Marcaine block (VATS-lobe-M). Thor-E patients expressed lower pain scores compared to VATS-M and VATS-lobe-M in the first 48 hours after surgery (p<0.001). Opiate use was also lower in the Thor-E patients compared to VATS-lobe-M patients, with 25% of the Thor-E patients not taking opiates by POD 5. Opiate use was not significantly different between Thor-E and VATS-E patients from POD5 to POD 13. The LOS was 3.2 days for Thor-E and 5.7 days for historic control thoracotomy lobectomy patients who received a Marcaine nerve block.
    
    Conclusion:
    Our study suggests that the pain relief provided by an Exparel block in thoracotomy patients compares favorably to that of VATS procedures in the immediate and extended postoperative period, and that Exparel paravertebral nerve blocks may also improve hospital length of stay.