Impact of long-acting local anesthesia on clinical and financial outcomes in laparoscopic colorectal surgery

Am J Surg. 2017 Jul;214(1):53-58. doi: 10.1016/j.amjsurg.2015.10.035. Epub 2016 Feb 27.

Abstract

Background: Our objective was to assess clinical and financial outcomes with long-acting liposomal bupicavaine (LB) in laparoscopic colorectal surgery.

Methods: Patients that received local infiltration with LB were strictly matched to a control group, and compared for postoperative pain, opioid use, length of stay (LOS), hospital costs, and complication, readmission, and reoperation rates.

Results: A total of 70 patients were evaluated in each cohort. Operative times and conversion rates were similar. LB patients had lower post-anesthesia care unit pain scores (P = .001) and used less opioids through postoperative day 3 (day 0 P < .01; day 1 P = .03; day 2 P = .02; day 3 P < .01). Daily pain scores were comparable. LB had shorter LOS (mean 2.96 vs 3.93 days; P = .003) and trended toward lower readmission, complication, and reoperation rates. Total costs/patient were $746 less with LB, a savings of $52,200 across the cohort.

Conclusions: Using local wound infiltration with LB, opioid use, LOS, and costs were improved after laparoscopic colorectal surgery. The additional medication cost was overshadowed by the overall cost benefits. Incorporating LB into a multimodal pain regiment had a benefit on patient outcomes and health care utilization.

Keywords: Enhanced recovery; Health care outcomes; Laparoscopic colorectal surgery; Pain management.

MeSH terms

  • Analgesics, Opioid / therapeutic use
  • Anesthetics, Local / administration & dosage*
  • Anesthetics, Local / economics
  • Bupivacaine / administration & dosage*
  • Bupivacaine / economics
  • Case-Control Studies
  • Colon / surgery*
  • Delayed-Action Preparations / economics
  • Drug Utilization / statistics & numerical data
  • Female
  • Humans
  • Laparoscopy*
  • Length of Stay / economics
  • Length of Stay / statistics & numerical data
  • Liposomes
  • Male
  • Middle Aged
  • Pain Measurement
  • Pain, Postoperative / prevention & control*
  • Patient Readmission / statistics & numerical data
  • Postoperative Complications
  • Rectum / surgery*
  • Reoperation / statistics & numerical data
  • Texas

Substances

  • Analgesics, Opioid
  • Anesthetics, Local
  • Delayed-Action Preparations
  • Liposomes
  • Bupivacaine