title: Reducing Opioid Adverse Events: A Safe Way to Improve Outcomes.
abstract: BACKGROUND
  Opioids are commonly used in the postoperative period to manage postsurgical pain. However, adverse side effects of opioids include respiratory depression, urinary retention, pruritus, vomiting, nausea, constipation, and increased risk of falls. Surgical site infiltration with extended release liposomal bupivacaine is effective in the multimodal care plan of managing postsurgical patients. The purpose of the present study was to examine the possible effects of liposomal bupivacaine on postoperative opioid adverse events following open hernia repair and laparoscopic colon resection surgery.
  
  
  METHODS
  The study population comprised 82 patients who had undergone open hernia repair or a laparoscopic colon resection. Forty-five of the 82 patients were treated with liposomal bupivacaine. Data were examined retrospectively from January 1, 2012 to August 31, 2012 in comparison with historical controls. Adverse opioid events measured included constipation, pruritus, vomiting, nausea, urinary retention, respiratory depression and fall risk. Statistical tools used were the Mann-Whitney U test, Pearson's chi-squared test, and Fisher's exact test.
  
  
  RESULTS
  The addition of liposomal bupivacaine did significantly (p<0.05) reduce urinary retention and respiratory depression. Additionally, from the perspective of hospital safety there was a significant reduction in patients at high risk of falls, from 16% to 8.4% as well as an increase in patients at low risk of falls, from 37.6% to 48.7%.
  
  
  CONCLUSIONS
  The findings of this study demonstrate that using liposomal bupivacaine can significantly reduce high-risk fall patients, increase low-risk fall patients as well as decrease urinary retention and respiratory depression in the postoperative setting. Given heightened consideration of the impact of sentinel events on hospital reimbursement since health care reforms in 2014, these results are important because they can mitigate complications associated with opioids in postsurgical pain management, and thereby reduce the costs of hospitalization.
authors.affiliation: Florida Hospital-Celebration Health, Professor of Surgery, University of Central Florida College of Medicine, Orlando, Florida.
authors.forename: Jay A
authors.initials: JA
authors.lastname: Redan
authors.affiliation: Florida Hospital-Celebration Health, Celebration, Florida.
authors.forename: Tina
authors.initials: T
authors.lastname: Wells
authors.affiliation: Florida Hospital-Celebration Health, Celebration, Florida.
authors.forename: Sandra
authors.initials: S
authors.lastname: Reeder
authors.affiliation: Florida Hospital-Celebration Health, Celebration, Florida.
authors.forename: Steven D
authors.initials: SD
authors.lastname: McCarus
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control / Q000706:statistics & numerical data; D000328:Adult; D000368:Aged; D002045:Bupivacaine / Q000008:administration & dosage* / Q000009:adverse effects; D003113:Colonoscopy / Q000706:statistics & numerical data; D057915:Drug Substitution / Q000706:statistics & numerical data; D005260:Female; D005431:Florida / Q000453:epidemiology; D059685:Herniorrhaphy / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008081:Liposomes; D008297:Male; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000453:epidemiology / Q000517:prevention & control*; D010149:Postoperative Pain / Q000453:epidemiology* / Q000517:prevention & control*; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology* / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014555:Urination Disorders / Q000453:epidemiology* / Q000517:prevention & control
chemical_list: D008081:Liposomes; D002045:Bupivacaine