Exparel® (Bupivacaine Liposome Injectable Suspension) as Adjunctive Pain Control in Adult Tonsillectomy: Reducing Post-Operative Opioid Use.

OBJECTIVES

To evaluate the effects of using Exparel® bupivacaine liposome suspension 1.3% (13.3 mg/mL) as an adjunct to standard of care medication in adult tonsillectomy patients.

STUDY

DESIGN

Randomized controlled trial.

SETTING

Community Hospital.

METHODS

The study arm (n = 22) received Exparel® bupivacaine liposome suspension 1.3% (13.3 mg/mL) as an adjunct to the standard of care (SOC) medication bupivacaine HCl 0.25% (2.5 mg/mL) with epinephrine (5 μg/mL). The control group (n = 20) received SOC bupivacaine HCl 0.25% with epinephrine (5 μg/mL). All injections were administered after the excision of the tonsil, prior to conclusion of the operative procedure. Pre- and post-operative clinicopathologic variables of interest were collated from electronic medical records and daily pain diaries. Results were analyzed via standard univariate statistics, linear mixed models, and Poisson regression.

RESULTS

The Exparel® + SOC group experienced significantly less pain at post operative day (POD) 3 compared to the control group (P < .05). Mean pain score decreased on average by 1.23 points in the Exparel® + SOC group and increased on average by 0.39 points in the control group (adj. P-value < .001). Similarly, analysis showed that maximum pain score decreased on average by 0.64 points in the Exparel® + SOC and increased on average by 0.61 points the control group (adj. P-value < .001). There was a statistically significant decrease in dose of oxycodone use between POD 3 and POD 5 within the Exparel® + SOC group (16.39 vs 7.22 mg, P-value = .035). The relative proportion of patients who took oxycodone was less in the Exparel® + SOC group compared to the control group across all PODs.

CONCLUSION

Use of Exparel® in adult tonsillectomy may decrease post-operative opioid use compared to standard of care treatment. These findings may serve as guidance for best practices in adult tonsillectomy.