Field block

Purpose:This study evaluates the role of liposomal bupivacaine in implant-based breast reconstruction.Methods:A prospective, randomized, single-blind trial of liposomal bupivacaine in implant-based breast reconstruction was performed. Patients in the control arm were treated with 20 mL 0.25% bupivacaine with epinephrine 1:200,000 to each breast pocket. Patients in the experimental arm were treated with 10 mL 1.3% liposomal bupivacaine delivered to each breast pocket. Pain scores were recorded over the course of patients’ hospital stay. Consumption of pain medications, benzodiazepines, and anti-emetics was monitored. Length of stay and other direct cost data were collected.Results:Twenty-four patients were enrolled, with 12 women randomized to each arm. Average postoperative pain scores were 3.66 for patients in the control arm and 3.68 for patients in the experimental arm. Opioid consumption was 1.43 morphine equivalent dosing/h for patients in the control arm and 0.76 morphine equivalent dosing/h for patients in the experimental arm (P = 0.017). Diazepam consumption was 0.348 mg/h for patients in the control arm and 0.176 mg/h for patients in the experimental arm (P = 0.011). Average length of hospital stay was 46.7 hours for patients in the control arm and 29.8 hours for patients in the experimental arm (P = 0.035). Average hospital charges were $18,632 for patients in the control arm and $10,828 for patients in the experimental arm (P = 0.039).Conclusions:Liposomal bupivacaine reduces opioid and benzodiazepine consumption, length of stay, and hospital charges. These data support a role for liposomal bupivacaine in implant-based breast reconstruction.

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“…Intraoperatively, each breast pocket was infiltrated to perform a field block as described by Buitelaar et al 12 including:…”

Section: Methodsmentioning

confidence: 99%

“…Along a line 1 cm posterior and parallel to the anterior axillary line, extending under the pectoralis major muscle in the axilla, targeting the lateral cutaneous branches of the second to seventh intercostal nerves 12 …”

Section: Methodsmentioning

confidence: 99%

Liposomal Bupivacaine in Implant-Based Breast Reconstruction

Motakef

Wong

Ingargiola

et al. 2017

Plastic and Reconstructive Surgery - Global Open

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“…In the past, longer-acting local anesthetics, such as bupivacaine HCl or ropivacaine, were commonly used in field block infiltrations. 38 , 39 More recently, a novel, prolonged-release local anesthetic, liposomal bupivacaine, marketed in the United States by Pacira Pharmaceuticals, Inc., Parsippany, N.J., as Exparel (bupivacaine liposome injectable suspension), has become available. 40 Liposomal bupivacaine is indicated for surgical-site infiltration and field block infiltrations where the anesthetic is placed in the fascial plane between muscles.…”

Section: Introductionmentioning

confidence: 99%

“…All patients preferred liposomal bupivacaine over their perceptions of an elastomeric pump device, and 97% reported they would want to receive liposomal bupivacaine should they need surgery again. 38 …”

Section: Introductionmentioning

confidence: 99%

Multimodal Analgesia in Breast Surgical Procedures: Technical and Pharmacological Considerations for Liposomal Bupivacaine Use

Afonso

Newman

Seeley

et al. 2017

Plastic and Reconstructive Surgery - Global Open

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“…For example, a field block for breast surgery consists of a straightforward technique in which local anesthetics are infiltrated on a deep subcutaneous level around the breast. 8,9 This block combines the placement of LA relatively near to the tumor, in contrast to a paravertebral block, with effective analgesia.…”

mentioning

confidence: 99%