title: Liposomal bupivacaine versus continuous infusion bupivacaine via an elastomeric pump for the treatment of postoperative pain.
abstract: OBJECTIVE
  The duration of analgesia and comparative efficacy of liposomal bupivacaine and an elastomeric bupivacaine pump in a diverse surgical population were determined.
  
  
  METHODS
  A retrospective cohort study was conducted to evaluate patient outcomes following liposomal bupivacaine and elastomeric bupivacaine pump use from January through June 2013. The primary objective of the study was to evaluate 24-hour postoperative opioid use (in morphine equivalents).
  
  
  RESULTS
  Sixty-seven liposomal bupivacaine and 262 elastomeric bupivacaine pump patients were included. Significant between-group differences were seen in American Society of Anesthesiologists physical status, patient-controlled analgesia use, postoperative nonopioid use, and surgical procedure. On univariate analysis, liposomal bupivacaine-in comparison with elastomeric bupivacaine pump -was associated with reduced median (interquartile range, IQR) 24-hour postoperative opioid use (33.0 mg morphine equivalents [IQR, 19.0-80.4 mg morphine equivalents] versus 70.4 mg morphine equivalents [IQR, 37.1-115.4 mg morphine equivalents], p < 0.001) and median 72-hour postoperative opioid use (61.3 mg morphine equivalents [IQR, 28.7-142.8 mg morphine equivalents] versus 115.9 mg morphine equivalents [IQR, 69.9-175.4 mg morphine equivalents], p < 0.001). However, after adjustment for potential confounders with linear regression analysis, study medication was not associated with a decrease in 24-hour (β coefficient for elastomeric bupivacaine pump: 10.26; 95% confidence interval [CI]: -8.42 to 28.95; p = 0.281) or 72-hour postoperative opioid use (β coefficient for elastomeric bupivacaine pump: 2.23; 95% CI: -29.88 to 34.34; p = 0.891).
  
  
  CONCLUSIONS
  No difference was found between patients who received liposomal bupivacaine compared with elastomeric continuous infusion bupivacaine from a traditional pump in 24- or 72-hour postoperative opioid utilization after adjustment for baseline differences.
authors.affiliation: Michael T. Kenes, Pharm.D., BCPS, is Medical ICU Clinical Specialist, Department of Pharmacy, Wake Forest Baptist Medical Center, Winston-Salem, NC. Mandy C. Leonard, Pharm.D., BCPS, is System Director, Drug Use Policy and Formulary Management; Seth R. Bauer, Pharm.D., FCCM, BCPS, is Medical ICU Clinical Specialist; and Marcia J. Wyman, Pharm.D., BCPS, is Drug Information Pharmacist, Department of Pharmacy, Cleveland Clinic, Cleveland, OH. mkenes2@wakemed.edu.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Kenes
authors.affiliation: Michael T. Kenes, Pharm.D., BCPS, is Medical ICU Clinical Specialist, Department of Pharmacy, Wake Forest Baptist Medical Center, Winston-Salem, NC. Mandy C. Leonard, Pharm.D., BCPS, is System Director, Drug Use Policy and Formulary Management; Seth R. Bauer, Pharm.D., FCCM, BCPS, is Medical ICU Clinical Specialist; and Marcia J. Wyman, Pharm.D., BCPS, is Drug Information Pharmacist, Department of Pharmacy, Cleveland Clinic, Cleveland, OH.
authors.forename: Mandy C
authors.initials: MC
authors.lastname: Leonard
authors.affiliation: Michael T. Kenes, Pharm.D., BCPS, is Medical ICU Clinical Specialist, Department of Pharmacy, Wake Forest Baptist Medical Center, Winston-Salem, NC. Mandy C. Leonard, Pharm.D., BCPS, is System Director, Drug Use Policy and Formulary Management; Seth R. Bauer, Pharm.D., FCCM, BCPS, is Medical ICU Clinical Specialist; and Marcia J. Wyman, Pharm.D., BCPS, is Drug Information Pharmacist, Department of Pharmacy, Cleveland Clinic, Cleveland, OH.
authors.forename: Seth R
authors.initials: SR
authors.lastname: Bauer
authors.affiliation: Michael T. Kenes, Pharm.D., BCPS, is Medical ICU Clinical Specialist, Department of Pharmacy, Wake Forest Baptist Medical Center, Winston-Salem, NC. Mandy C. Leonard, Pharm.D., BCPS, is System Director, Drug Use Policy and Formulary Management; Seth R. Bauer, Pharm.D., FCCM, BCPS, is Medical ICU Clinical Specialist; and Marcia J. Wyman, Pharm.D., BCPS, is Drug Information Pharmacist, Department of Pharmacy, Cleveland Clinic, Cleveland, OH.
authors.forename: Marcia J
authors.initials: MJ
authors.lastname: Wyman
mesh_terms: D000328:Adult; D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D015331:Cohort Studies; D020724:Elastomers; D005260:Female; D006801:Humans; D007260:Infusion Pumps; D008081:Liposomes; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000175:diagnosis* / Q000188:drug therapy*; D011108:Polymers; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D020724:Elastomers; D008081:Liposomes; D011108:Polymers; C036925:elastomeric polymer; D002045:Bupivacaine