title: Postoperative Pain and Length of Stay Lowered by Use of Exparel in Immediate, Implant-Based Breast Reconstruction.
abstract: BACKGROUND
  Patients undergoing mastectomy and prosthetic breast reconstruction have significant acute postsurgical pain, routinely mandating inpatient hospitalization. Liposomal bupivacaine (LB) (Exparel; Pacira Pharmaceuticals, Inc., Parsippany, N.J.) has been shown to be a safe and effective pain reliever in the immediate postoperative period and may be advantageous for use in mastectomy and breast reconstruction patients.
  
  
  METHODS
  Retrospective review of 90 immediate implant-based breast reconstruction patient charts was completed. Patients were separated into 3 groups of 30 consecutively treated patients who received 1 of 3 pain treatment modalities: intravenous/oral narcotic pain control (control), bupivacaine pain pump, or LB injection. Length of hospital stay, patient-reported Visual Analog Scale (VAS) pain scores, postoperative patient-controlled analgesia usage, and nausea-related medication use were abstracted and subjected to analysis of variance and multiple linear-regression analysis, as appropriate.
  
  
  RESULTS
  Subjects were well-matched for age (P = 0.24) regardless of pain-control modality. Roughly half (53%) of control and pain pump-treated subjects had bilateral procedures, as opposed to 80% of LB subjects. Mean length of stay for LB subjects was significantly less than control (1.5 days vs 2.00 days; P = 0.016). LB subjects reported significantly lower VAS pain scores at 4, 8, 12, 16, and 24 hours compared with pain pump and control (P < 0.01). There were no adverse events in the LB group.
  
  
  CONCLUSIONS
  Use of LB in this group of immediate breast reconstruction patients was associated with decreased patient VAS pain scores in the immediate postoperative period compared with bupivacaine pain pump and intravenous/oral narcotic pain management and reduced inpatient length of stay.
authors.affiliation: Section of Plastic and Reconstructive Surgery, University of Chicago Pritzker School of Medicine, Chicago, Ill.; Division of Plastic and Reconstructive Surgery, NorthShore University HealthSystem, Evanston, Ill.; Department of Surgery, NorthShore University HealthSystem, Evanston, Ill.; Department of Pharmacy, NorthShore University HealthSystem, Evanston, Ill.; and Department of Anesthesia, NorthShore University HealthSystem, Evanston, Ill.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Butz
authors.affiliation: Section of Plastic and Reconstructive Surgery, University of Chicago Pritzker School of Medicine, Chicago, Ill.; Division of Plastic and Reconstructive Surgery, NorthShore University HealthSystem, Evanston, Ill.; Department of Surgery, NorthShore University HealthSystem, Evanston, Ill.; Department of Pharmacy, NorthShore University HealthSystem, Evanston, Ill.; and Department of Anesthesia, NorthShore University HealthSystem, Evanston, Ill.
authors.forename: Deana S
authors.initials: DS
authors.lastname: Shenaq
authors.affiliation: Section of Plastic and Reconstructive Surgery, University of Chicago Pritzker School of Medicine, Chicago, Ill.; Division of Plastic and Reconstructive Surgery, NorthShore University HealthSystem, Evanston, Ill.; Department of Surgery, NorthShore University HealthSystem, Evanston, Ill.; Department of Pharmacy, NorthShore University HealthSystem, Evanston, Ill.; and Department of Anesthesia, NorthShore University HealthSystem, Evanston, Ill.
authors.forename: Veronica L M
authors.initials: VL
authors.lastname: Rundell
authors.affiliation: Section of Plastic and Reconstructive Surgery, University of Chicago Pritzker School of Medicine, Chicago, Ill.; Division of Plastic and Reconstructive Surgery, NorthShore University HealthSystem, Evanston, Ill.; Department of Surgery, NorthShore University HealthSystem, Evanston, Ill.; Department of Pharmacy, NorthShore University HealthSystem, Evanston, Ill.; and Department of Anesthesia, NorthShore University HealthSystem, Evanston, Ill.
authors.forename: Brittany
authors.initials: B
authors.lastname: Kepler
authors.affiliation: Section of Plastic and Reconstructive Surgery, University of Chicago Pritzker School of Medicine, Chicago, Ill.; Division of Plastic and Reconstructive Surgery, NorthShore University HealthSystem, Evanston, Ill.; Department of Surgery, NorthShore University HealthSystem, Evanston, Ill.; Department of Pharmacy, NorthShore University HealthSystem, Evanston, Ill.; and Department of Anesthesia, NorthShore University HealthSystem, Evanston, Ill.
authors.forename: Eric
authors.initials: E
authors.lastname: Liederbach
authors.affiliation: Section of Plastic and Reconstructive Surgery, University of Chicago Pritzker School of Medicine, Chicago, Ill.; Division of Plastic and Reconstructive Surgery, NorthShore University HealthSystem, Evanston, Ill.; Department of Surgery, NorthShore University HealthSystem, Evanston, Ill.; Department of Pharmacy, NorthShore University HealthSystem, Evanston, Ill.; and Department of Anesthesia, NorthShore University HealthSystem, Evanston, Ill.
authors.forename: Jeff
authors.initials: J
authors.lastname: Thiel
authors.affiliation: Section of Plastic and Reconstructive Surgery, University of Chicago Pritzker School of Medicine, Chicago, Ill.; Division of Plastic and Reconstructive Surgery, NorthShore University HealthSystem, Evanston, Ill.; Department of Surgery, NorthShore University HealthSystem, Evanston, Ill.; Department of Pharmacy, NorthShore University HealthSystem, Evanston, Ill.; and Department of Anesthesia, NorthShore University HealthSystem, Evanston, Ill.
authors.forename: Catherine
authors.initials: C
authors.lastname: Pesce
authors.affiliation: Section of Plastic and Reconstructive Surgery, University of Chicago Pritzker School of Medicine, Chicago, Ill.; Division of Plastic and Reconstructive Surgery, NorthShore University HealthSystem, Evanston, Ill.; Department of Surgery, NorthShore University HealthSystem, Evanston, Ill.; Department of Pharmacy, NorthShore University HealthSystem, Evanston, Ill.; and Department of Anesthesia, NorthShore University HealthSystem, Evanston, Ill.
authors.forename: Glenn S
authors.initials: GS
authors.lastname: Murphy
authors.affiliation: Section of Plastic and Reconstructive Surgery, University of Chicago Pritzker School of Medicine, Chicago, Ill.; Division of Plastic and Reconstructive Surgery, NorthShore University HealthSystem, Evanston, Ill.; Department of Surgery, NorthShore University HealthSystem, Evanston, Ill.; Department of Pharmacy, NorthShore University HealthSystem, Evanston, Ill.; and Department of Anesthesia, NorthShore University HealthSystem, Evanston, Ill.
authors.forename: Mark
authors.initials: M
authors.lastname: Sisco
authors.affiliation: Section of Plastic and Reconstructive Surgery, University of Chicago Pritzker School of Medicine, Chicago, Ill.; Division of Plastic and Reconstructive Surgery, NorthShore University HealthSystem, Evanston, Ill.; Department of Surgery, NorthShore University HealthSystem, Evanston, Ill.; Department of Pharmacy, NorthShore University HealthSystem, Evanston, Ill.; and Department of Anesthesia, NorthShore University HealthSystem, Evanston, Ill.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Howard