MP72-14 PERIOPERATIVE INJECTION OF LIPOSOMAL BUPIVACAINE REDUCES NARCOTIC MEDICATION REQUIREMENT AFTER LAPARO-ENDOSCOPIC SINGLE SITE DONOR NEPHRECTOMY WITH SHORTER OPERATING TIME THAN SUB-FASCIAL CONTINUOUS LOCAL ANESTHESIA

Abstract

You have accessJournal of UrologyTransplantation & Vascular Surgery II1 Apr 2014MP72-14 PERIOPERATIVE INJECTION OF LIPOSOMAL BUPIVACAINE REDUCES NARCOTIC MEDICATION REQUIREMENT AFTER LAPARO-ENDOSCOPIC SINGLE SITE DONOR NEPHRECTOMY WITH SHORTER OPERATING TIME THAN SUB-FASCIAL CONTINUOUS LOCAL ANESTHESIA Adam B. Hollander, Jason M. Scovell, Miguel A. Mercado, Judy M. Choi, Edward J. Sanchez, Lambros Stamatakis, Alvin Goh, Richard E. Link, and Wesley A. Mayer Adam B. HollanderAdam B. Hollander More articles by this author , Jason M. ScovellJason M. Scovell More articles by this author , Miguel A. MercadoMiguel A. Mercado More articles by this author , Judy M. ChoiJudy M. Choi More articles by this author , Edward J. SanchezEdward J. Sanchez More articles by this author , Lambros StamatakisLambros Stamatakis More articles by this author , Alvin GohAlvin Goh More articles by this author , Richard E. LinkRichard E. Link More articles by this author , and Wesley A. MayerWesley A. Mayer More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2253AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Improving pain control after donor nephrectomy may shorten recovery and reduce barriers to donation. We previously presented data showing that sub-fascial continuous local anesthesia (SFCLA) reduced the need for narcotic medication after laparo-endoscopic single site donor nephrectomy (LESS-DN). Here, we examine our experience with liposomal bupivacaine (LB), a long-acting injectable local anesthetic, and compare its efficacy to SFCLA and patient-controlled analgesia (PCA). METHODS We retrospectively analyzed all cases of LESS-DN at our institution by three surgeons (AG, REL, WAM). Patients who received adjunct perioperative analgesia were administered either LB (Exparel®, Pacira Pharmaceuticals, Parsippany NJ) or SFCLA (On-Q Pain Buster®, I-Flow, Lake Forest CA); the others received morphine PCA. In the first group, 20 mL of 1.3% LB was diluted with 40 mL normal saline and injected sub-facially before closure of the fascia. For the SFCLA group, sub-fascial tunneled catheters and a ropivacaine pump were placed. Total narcotic use was converted to IV morphine equivalents. Maximum visual analog pain scores (VAS) were noted. Cost of adjunct perioperative analgesia was compared. Statistical analysis consisted of student’s T-test, Chi-square, and ANOVA, with significance < 0.05. RESULTS 195 patients underwent LESS-DN between October 2011 and September 2013. Pain was managed with LB (n=50), SFCLA (n=68), or PCA (n=77). Patients managed with PCA used more narcotics than those on LB (63.3 mg vs. 29.4 mg, p<0.01) or SFCLA (vs. 32.9 mg, p<0.01). Narcotic use was similar between LB and SFCLA (p=0.43). PCA patients had a lower max VAS than patients on LB (5.2 vs. 6.3, p=0.02) or SFCLA (vs. 6.2, p=0.04). Operating time was longer for SFCLA compared to LB (219.8 min vs. 199.3 min, p<0.01) and PCA (vs. 202 min, p<0.01). There was no difference in length of stay (p=0.89), age (p=0.45), gender (p=0.85), BMI (p=0.20), operative side (p=0.98), or pre- and post-operative GFR (p=0.95, p=0.45). The cost of LB is approximately $285; the cost of SFCLA is approximately $460 for the device plus $400 for the ropivacaine. CONCLUSIONS LB is as effective as SFCLA in providing perioperative analgesia while decreasing OR time, likely due to its comparative ease of administration. Although patients with PCA showed slightly lower maximum VAS scores than those with LB or SFCLA, it is not likely clinically significant. Cost of LB is significantly lower than SFCLA. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e828-e829 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Adam B. Hollander More articles by this author Jason M. Scovell More articles by this author Miguel A. Mercado More articles by this author Judy M. Choi More articles by this author Edward J. Sanchez More articles by this author Lambros Stamatakis More articles by this author Alvin Goh More articles by this author Richard E. Link More articles by this author Wesley A. Mayer More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...