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HOUSTON -- Liposomal bupivacaine (EXPAREL), a single-dose, non-opioid, was linked to improved patient outcomes in those undergoing laparoscopic colorectal surgery, according to research reported here.
In a national sample of 2,392 inpatients, total opioid use for the hospital episode (459.0 versus 482.4 mg, P<0.001) and the rate of opioid-related adverse events (5.5% versus 8.4%, P=0.005) were significantly lower among those who received EXPAREL compared with controls, said Deborah S. Keller, MS, MD, of Baylor University Medical Center
Action Points
- Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
"Significant reductions in opioid utilization, opioid-related adverse events, and mean length of stay are seen with the medication on board, with comparable or lower resource utilization and costs," she told 鶹ý at the .
For the study, Keller and colleagues reviewed the Premier Perspectives Chargemaster Database for patients who underwent laparoscopic right colectomy from Jan. 1, 2011 to Sept. 31, 2015.
Of 28,541 identified cases, 8,805 were patients at hospitals that provided the long-acting liposomal bupivacaine. All patients were identified by ICD-9 primary procedure code (17.33) and stratified to be in the EXPAREL cohort or a control group. The groups were then 1:1 propensity-score matched on age, gender, comorbidity, region, payer, and hospital characteristics. The operative times were found to be comparable between the two groups.
Patients who received EXPAREL had significantly shorter mean time in a post-anesthesia care unit (1.7 versus 2.0 hours, P<0.001), as well as shorter mean length of stay (5.5 versus 6.1 days, P<0.001).
Postoperatively, the EXPAREL group had significantly lower readmissions at 60 and 90 days compared with the controls: 4.3% versus 7.0%, P=0.004 and 4.9% versus 8.2%, P=0.001, respectively.
Keller and her team also found that despite the additional cost of the opioid-sparing agent, the total costs were still slightly lower in the EXPAREL group ($14,834 versus $14,952). However, there is a potential for more substantial cost savings with wider use of this agent: "These results have implications for expanding use with this opioid-sparing pain-management intervention to realize enhanced clinical and financial benefits," Keller concluded.
Asked for her thoughts on the findings, Gretchen Weber, MD, of Genesis Healthcare System in Ohio, said that her hospital uses EXPAREL quite a bit. "I found good results with it. Less phone calls, and it's easier to send patients home." She acknowledged that while EXPAREL is more expensive, it does pay off -- "especially for outpatient surgery."
Keller also referred to the reduction in opioid consumption with the medication as "promising."
"As we are fighting an opioid epidemic in the U.S., this could be a tool to help reduce opioid dependency and other complications, but controlled trials are needed to investigate these outcomes," she said.
Daniel Broom, R&D director at Medtronic, agreed that there are benefits to using opioid-sparing pain agents like EXPAREL: "Certainly the opioid-sparing pain management and use of opioids in general is a huge issue right now. Ways like this where you can have pain management without having to use a lot of opioids is pretty timely and pretty critical," he said.
Primary Source
Society of American Gastrointestinal and Endoscopic Surgeons meeting
Keller D, et al "Evaluating the impact of opioid-sparing pain management agents in laparoscopic colorectal surgery: results from a national sample" SAGES 2017; Abstract P006.