Liposomal Bupivacaine Decreases Postoperative Length of Stay and Opioid Use in Patients Undergoing Radical Cystectomy
| Autor: | Sima P. Porten, Kyle Zuniga, Kirsten Greene, Carissa Chu, Samuel L. Washington, Lauren Law, Matthew R. Cooperberg, Ann A. Lazar, Raj S. Pruthi, Rosa Rodriguez-Monguio, Candy Tsourounis, Peter R. Carroll, Maxwell V. Meng, Tracy Kuo Lin, Lee-lynn Chen |
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| Rok vydání: | 2020 |
| Předmět: |
Male
Urology medicine.medical_treatment 030232 urology & nephrology Urinary Diversion Single Center Cystectomy 03 medical and health sciences 0302 clinical medicine Medicine Humans Pain Management In patient Anesthetics Local Aged Pain Measurement Retrospective Studies Pain Postoperative business.industry Urinary diversion Retrospective cohort study Perioperative Length of Stay Middle Aged Liposomal Bupivacaine Opioid-Related Disorders Bupivacaine Analgesia Epidural Analgesics Opioid Treatment Outcome Opioid 030220 oncology & carcinogenesis Anesthesia Female business medicine.drug |
| Zdroj: | Urology. 149 |
| ISSN: | 1527-9995 2015-2019 |
| Popis: | To analyze differences in length of stay, opioid use, and other perioperative outcomes in patients undergoing radical cystectomy with urinary diversion who received either liposomal bupivacaine (LB) or epidural analgesia.This was a single center, retrospective cohort study of patients undergoing open radical cystectomy with urinary diversion from 2015-2019 in the early recovery after surgery (ERAS) pathway. Patients received either LB or epidural catheter analgesia for post-operative pain control. LB was injected at the time of fascial closure to provide up to 72 hours of local analgesia. The primary outcome was post-operative length of stay. Secondary outcomes were post-operative opioid use, time to solid food, time to ambulation, and direct hospitalization costs. Multivariable Cox proportional hazards regression was used to determine associations between analgesia type and discharge.LB use was independently associated with shorter post-operative length of stay compared to epidural use (median (IQR) 4.9 days (3.9-5.8) vs 5.9 days (4.9-7.9), P.001), less total opioid use (mean 188.3 vs 612.2 OME, P.001), earlier diet advancement (mean 1.6 vs 2.4 days, P.001), and decreased overall direct costs ($23,188 vs $29,628, P.001). 45% of patients who received LB were opioid-free after surgery, none in the epidural group. On multivariable Cox proportional hazards regression modeling, LB use was independently associated with earlier discharge (HR 2.1, IQR 1.0-4.5).Use of LB in open radical cystectomy is associated with reduced LOS, less opioid exposure, and earlier diet advancement. |
| Databáze: | OpenAIRE |
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