Exparel® vs Epidural for Pain Management After Major Thoracic Open Surgical Procedures
Luis E. De Leon1, Michael T. Jaklitsch1, Phillip M. Hartigan2, Scott J. Swanson1, Raphael Bueno1, Namrata Patil1
1Division of Thoracic Surgery, Brigham and Women's Hospital / Harvard Medical School, Boston, MA; 2Department of Anesthesiology, Brigham and Women's Hospital / Harvard Medical School, Boston MA, USA
Background: The purpose of this study was to evaluate how Exparel® compared to epidural anesthesia in patients undergoing major thoracic surgery through a thoracotomy approach at a large-volume-single institution.
Methods: All patients undergoing a segmentectomy, lobectomy, pneumonectomy or esophagectomy, through a thoracotomy or mini-thoracotomy between March 1st and December 31st, 2018 were included. Patients were monitored daily to identify postoperative morbidity and mortality. Pain scores were obtained in the immediate postoperative period, and at 12, 24 and 48 hours. Patients were divided into two groups those who received epidural analgesia and those who received Exparel® (bupivacaine liposome injectable suspension).
Results: During the study period, 90 patients underwent one of the four index major surgical procedures through a thoracotomy or mini-thoracotomy. Median age at surgery was 66 years (23 – 90) and it was similar between groups. Surgical procedures 6 (%) segmentectomies, 53 (%) lobectomies, 16 (%) pneumonectomies, and 15 (%) esophagectomies. Fewer patients experienced complications in the Exparel® group. Median length of stay was significantly lower in patients who received Exparel®, [5 days (3 – 42) vs 7 days (3 – 38), p=0.02]. Median pain scores were lower in patients who received Exparel® at 24 hours.
Conclusion: Exparel is a good alternative to epidural anesthesia in the postoperative pain management of patients undergoing major thoracic surgery. It is associated with a shorter hospital length of stay, less prevalence of complications and lower pain scores when compared to epidural anesthesia.
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