A Retrospective Cross-Sectional Study of the Effect of Liposomal Bupivacaine on Postoperative Opioid Prescribing After Third Molar Extraction

Abstract

Reducing opioid prescriptions after third molar extraction may decrease the risk of opioid dependence. This study compared prescribed morphine milligram equivalents (MMEs) in patients undergoing mandibular third molar removal with and without use of liposomal bupivacaine (LB).Methods: This retrospective cross-sectional study included deidentified data from electronic medical records of patients who underwent extraction of $1 partial bony-or full bony-impacted mandibular third molar at 2 oral surgery centers in the United States in 2012 or 2018. The primary predictor variable was use of LB 133 mg. The primary outcome variable was total prescribed opioids in MMEs. The secondary outcome variable was rate of prescription refills. Both univariate and multivariable regression analyses were used to compare MMEs between groups with a significance level of P < .05.Results: The study sample included 600 subjects (n = 300 each for LB and non-LB groups). Mean age (22-24 years) and sex distribution (55%-58% female) were comparable between groups, although significant differences were observed in anesthesia type and race distribution (P < .05). In univariate analysis, the LB group was prescribed 59% fewer MMEs than the non-LB group (47.1 vs 113.8 MMEs; rate ratio, 0.41 [0.39-0.44]; P < .0001). After adjustment for age, sex, anesthesia type, American Society of Anesthesiologists physical status classification, and complications, the LB group was prescribed significantly fewer total opioids (adjusted MMEs, 44.9 vs 109.5; rate ratio, 0.41 [95% confidence interval, 0.39-0.44]; P < .0001) and had a significantly lower opioid prescription refill rate (3.3% vs 7.7%; odds ratio, 0.38 [95% confidence interval, 0.16-0.90]; P = .028) than the non-LB group. Complication rates were comparable between groups.Conclusions: Patients undergoing third molar extraction and receiving LB were prescribed significantly fewer opioids than patients who did not receive LB, with a lower refill rate. Use of LB may reduce opioid prescriptions for postsurgical analgesia.

Lingual bone thickness in the apical region of the horizontal mandibular third molar: A cross-sectional study in young Japanese

“…Extraction of mandibular third molars is a common oral and maxillofacial surgical procedure, as described above. Therefore, research and advances in extraction techniques and preoperative assessment should continue [11][12][13][14][15]. Recently, simulation of tooth extraction surgery based on three-dimensional image construction technology has also been reported, and innovation in tooth extraction surgery may occur with the development of digital technology [14,15].…”

Pain management following dental trauma and surgical procedures

“…Liposomal bupivacaine (LB) 28–32 (Exparel®) is an injectable, amide‐type local anesthetic formulated to provide postsurgical local analgesia for up to 72 h. It is solely indicated for postsurgical pain control by infiltration injection around the surgical incision 29 . LB is not indicated for administration by nerve block due to its prolonged analgesic effect (potentially leading to an increase in the occurrence of self‐inflicted soft tissue injury).…”

“…LB is not indicated for administration by nerve block due to its prolonged analgesic effect (potentially leading to an increase in the occurrence of self‐inflicted soft tissue injury). Lieblich demonstrated a 59% reduction in total prescribed opioids (47.1 MMEs [morphine milligram equivalents] vs. 113.8 MMEs) in patients receiving LB versus those not receiving it 30 …”

“…This also increases the risk of self-inflicted soft tissue injury-chewing or biting of the "numb" lip or tongue. [7][8][9]27 Liposomal bupivacaine (LB) [28][29][30][31][32]…”