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

Afonso, Anoushka M.; Newman, Martin; Seeley, Neil; Hutchins, Jacob; Smith, Kevin L.; Mena, Gabriel E.; Selber, Jesse C.; Saint‐Cyr, Michel; Gadsden, Jeff

doi:10.1097/gox.0000000000001480

Cited by 18 publications

(22 citation statements)

References 43 publications

(78 reference statements)

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“…These promising outcomes provide a motivating impetus for a diverse range of surgical specialties to adopt ERAS guidelines. 4,5,12,15,16 Yet, despite their growing popularity, few authors have examined the adoption of ERAS protocols. To our knowledge, this is the first study examining the adherence to ERAS protocols by reconstructive breast surgeons.…”

Section: Discussionmentioning

confidence: 99%

Adoption of Enhanced Recovery after Surgery Protocols in Breast Reconstruction in Alberta Is High before a Formal Program Implementation

Redwood

Matkin

Temple‐Oberle

2019

Plastic and Reconstructive Surgery - Global Open

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Section: Discussionmentioning

confidence: 99%

Adoption of Enhanced Recovery after Surgery Protocols in Breast Reconstruction in Alberta Is High before a Formal Program Implementation

Redwood

Matkin

Temple‐Oberle

2019

Plastic and Reconstructive Surgery - Global Open

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“…Although this is an interesting discovery, discharge times are impacted by many variables such as postoperative pain, emetic symptoms, and system-related delays that was not included in our statistical model. Further exploration is warranted because liposome bupivacaine is considerably more expensive than plain bupivacaine or ropivacaine [ 47 , 48 ] and may not have a pharmacoeconomic advantage when compared to plain bupivacaine or ropivacaine [ 49 , 50 ].…”

Section: Discussionmentioning

confidence: 99%

Liposome Bupivacaine Compared to Plain Local Anesthetics to Reduce Postsurgical Pain: An Updated Meta-Analysis of Randomized Controlled Trials

Kendall

Alves

Oliveira

2018

Pain Research and Treatment

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Objective Peripheral nerve blocks for postoperative analgesia have improved block success, but analgesia efficacy has been limited by the short duration of traditional local anesthetics. The results of randomized trials comparing liposome bupivacaine with conventional local anesthetic formulations (e.g., plain bupivacaine and ropivacaine) have generated conflicting results. This study was conducted to systematically review the effectiveness of analgesic efficacy of liposome bupivacaine infiltration at the surgical site versus plain local anesthetic bupivacaine or ropivacaine in patients undergoing surgery. Methods PRISMA statement guidelines were followed. A search of electronic databases National Library of Medicine's PubMed database, Cochrane Database of Systematic Reviews, Embase, and Google Scholar from January 2012 to September 2017 was performed. Among the 1,612 records identified, 9 randomized controlled trials involving 779 patients were eligible for data extraction and meta-analysis. Results Liposome bupivacaine did not reduce postsurgical pain at rest compared to plain local anesthetics at 24 and 48 hours after surgery. Moreover, liposome bupivacaine did not reduce postoperative opioid consumption at 24, 48, or 72 hours when compared to plain local anesthetics. Liposome bupivacaine did reduce postoperative nausea when compared to plain local anesthetics (P =<0.3). There was no significant difference in hospital length of stay between study groups, the use of plain bupivacaine or ropivacaine, or among orthopedic or nonorthopedic procedures. No manifestations of local anesthetic toxicity were reported. Conclusions Our results suggest that liposome bupivacaine does not have an analgesic advantage when compared to plain local anesthetics at the surgical site for patients undergoing surgical procedures.

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“…7 Use of long acting local anesthetics to reduce pain and promote mobility. 109-112 Utilize surgical techniques to decrease or prevent Jackson Pratt drain use. 113,114 …”

Section: Eras Bl Protocolmentioning

confidence: 99%

“…125,126 PO food ad lib. Advance as tolerated Postoperative pain medications—opioid reduction protocol (limited narcotics with liposound, bupivacaine, benzodiazepines, and antiemetics, transition to OTCs 110-114,127 TED hose worn until POD 5. SCD use at home while not ambulating.…”

Section: Eras Bl Protocolmentioning

confidence: 99%

An Enhanced Recovery After Surgery (ERAS) Protocol for Outpatient BodyLift Surgery

Nuveen

Matthesen²,

Cox

et al. 2020

Am J Cosmet Surg

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The concept of enhanced recovery after surgery (ERAS) was developed in 2001 in order to create a multimodal, scientifically based approach to the development and audit of protocols for improving outcomes after surgical procedures. These protocols undergo constant evolution and evaluation toward the goal of quality of recovery. The BodyLift (BL) is the procedure that most comprehensively addresses the cosmetic needs of patients after massive weight loss (MWL). In the course of performing 136 consecutive outpatient BL surgeries over 7 years, we have developed a management protocol that has provided consistently high patient satisfaction, minimized frequent complications, and has documented 100% safety in all cases performed without deep vein thrombosis (DVT), transfusion and with 1 postoperative hospital admission. Each evidence-based component in the protocol was instituted to reduce risk of complications known to be most commonly associated with circumferential body contouring surgery. ERAS protocols are now widely used in many other surgical subspecialties. These protocols have the common goal of returning the patient to normal function as expeditiously as possible and are associated with decreased complications as well as shorter length-of-stay (LOS) and reduced costs. We have enumerated the many components of our protocol and aligned each with elements of an ERAS paradigm. In our retrospective review of 7 years of BL surgery (n = 136), this protocol has reduced both major and minor complications to previously unpublished levels. Our independently formulated ERAS protocol for outpatient BL surgery aligns closely with the ERAS concept, limiting surgical stress, thus reducing complications and affording a smooth and predictable perioperative experience. This is of importance for elective cosmetic surgery patients, who often have high expectations for an uneventful recovery and are unaccepting of potentially out-of-pocket costs associated with complications.

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

Abstract: Supplemental Digital Content is available in the text.

Cited by 18 publications

References 43 publications

Adoption of Enhanced Recovery after Surgery Protocols in Breast Reconstruction in Alberta Is High before a Formal Program Implementation

Adoption of Enhanced Recovery after Surgery Protocols in Breast Reconstruction in Alberta Is High before a Formal Program Implementation

Liposome Bupivacaine Compared to Plain Local Anesthetics to Reduce Postsurgical Pain: An Updated Meta-Analysis of Randomized Controlled Trials

An Enhanced Recovery After Surgery (ERAS) Protocol for Outpatient BodyLift Surgery

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