Extended Release Liposomal Bupivacaine Injection (Exparel) for Early Postoperative Pain Control Following Pharyngoplasty

Background:Liposomal bupivacaine (LB, Exparel) is a long-acting local anesthetic reported to decrease postoperative. The authors demonstrate the first safe use of LB in pediatric patients with improved pain control following pharyngoplasty.Methods:Retrospective case-control of all the patients who underwent pharyngoplasty at a tertiary craniofacial center from March 2010 to June 2016. Treatment group (TG) administered 1.3% LB and 0.5% bupivacaine and 1:200,000 epinephrine. Control group (CG) administered 0.5% lidocaine with 1:200,000 epinephrine. Pain scores, oral intake, opioids administered, and duration of hospitalization were measured.Results:Sixty patients (30 males, 30 females; average age 6.22.4 years, weight 20.9 +/- 6.8kg) were evenly divided into a TG that received 3.5 +/- 2.1mL (2.6 +/- 1.9mg/kg) LB and 2.0 +/- 2.3mL 0.5% bupivacaine and a CG that received 2.7 +/- 3.2mL lidocaine. Treatment group patients had lower initial face, legs, activity, cry, consolability pain scale scores (0.1 +/- 0.55/10, P=0.0049; CG 4.5 +/- 1.1/10, P=0.00061) and no significant inpatient pain score difference 0 to 36hours postoperative (P=0.32-0.53). Oral intake was tolerated 0.21 +/- 0.12 days (P<0.0001) earlier by the TG and with greater first 24-hour average volume (377.6 +/- 351.9 cc, P<0.0001). Treatment group patients were discharged 1.8 +/- 0.87 days (P=0.00023) earlier and required lower average opioids (15.1 +/- 11.2mg hydrocodone-equivalents) than CG (27.5 +/- 19.1mg hydrocodone-equivalents; P=0.0017).Conclusions:Liposomal bupivacaine is safe in pediatric patients, associated with less opioids, increased and earlier oral intake, and shorter hospital stay.