Plastic Surgery Research Council
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PSRC 60th Annual Meeting
Program and Abstracts

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Efficacy and Economic Advantage of Exparel Intercostal Nerve Blocks for Pain Management in 1st Stage Implant Based Breast Reconstruction Patients
Suzette G. Miranda, MD, Thomas Gallagher, BA, Hakim K. Said, MD.
University of Washington, Seattle, WA, USA.

PURPOSE: Prosthetic two stage implant based breast reconstruction after mastectomy is one of the available options for some women following mastectomy. Postoperative pain from this procedure may respond poorly to opioids and is known to be severe from breast augmentation studies. Intercostal bupivacaine nerve blocks for the management of pain in breast surgery has led to increased patient satisfaction and reduced length of hospital stay. A newer, extended release formulation of bupivacaine, DepoFoam bupivacaine (EXPAREL, Pacira Pharmaceuticals, Inc., Parsippany, NJ, USA) has been shown to have prolonged postsurgical analgesia lasting up to 72 hours and to have a higher safety margin and level of analgesia when compared to conventional bupivacaine. It has recently been shown to safely reduce postoperative pain and decrease hospital stay in an array of surgical procedures across surgical specialties. We hypothesize that the use of Exparel in intercostal nerve blocks for tissue expander placement in breast reconstruction will decrease hospital length of stay, reduce hospital costs and decrease the use of pain medication in the hospital.
METHODS: A retrospective chart review was performed to identify patients who underwent the 1st of two stage implant based breast reconstruction with tissue expanders at a regional tertiary care hospital. Patients were divided into two groups. Group A patients received standard pre-protocol care which could include narcotics or intercostal nerve blocks with bupivacaine after tissue expander placement. Group B patients received intercostal nerve blocks with Exparel. Demographics between both groups were compared. Additionally, the amount of time spent in the hospital (classifying them as inpatient versus ambulatory), total charges and total cost between the two groups were compared. Finally, the amount of pain medication consumption between each group was also evaluated.
RESULTS: A total of 115 patients fulfilled inclusion criteria. Fifty-five patients received standard pre-protocol care (group A) while 60 patients received liposomal bupivacaine intercostal blocks (group B). Sixty-two percent of patients in group A were inpatient while 38% of patients were considered ambulatory. In contrast, 18% of patients in group B were inpatient while 82% were ambulatory. Mean charges and cost per patient were decreased from group A to group B seen in Table 1. In addition, the average pain medication consumption in morphine equivalents was lower on POD 0 and 1 for group B patients when compared to group A (Graph 1).
CONCLUSION: To conclude, extended release form of bupivacaine led to a dramatic decrease in the number of patients requiring an inpatient stay. Furthermore, patients who received this new liposomal form had decreased hospital costs and required less narcotics compared to traditional pre-protocol care.








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