Purpose
To compare pain experience and opioid use after distal radius fracture repair surgery
performed with perioperative infiltration of the local anesthesia bupivacaine hydrochloride
(Marcaine; Pfizer, New York, NY) or bupivacaine liposome (Exparel; Pacira, Parsippany,
NJ).
Methods
We conducted a prospective comparison of consecutive patients scheduled to undergo
distal radius fracture repair surgery. Patients were randomized to either Marcaine
or Exparel. Patients in the Marcaine group received 20 mL 0.5% bupivacaine without
epinephrine into the incision and surgical site before incision. Patients in the Exparel
group first received 10 mL 0.5% Marcaine with no epinephrine into the incision and
surgical site before incision; then, upon completion of the surgery and wound closure,
they also received 10 mL Exparel into the same site that had been preinjected with
Marcaine. All operations were performed with the same surgical technique. Daily opioid
pill consumption, pain levels, and any adverse reactions were recorded from postoperative
days 0 to 5.
Results
On the day of surgery, patients in the Exparel group reported significantly lower
pain levels (3.9 vs 5.8) and consumed significantly fewer prescribed opioid pills
(1.2 vs 2.0) compared with patients in the Marcaine group. However, there were no
other significant differences between the Exparel and Marcaine groups on any subsequent
days or in the total number of pills consumed at the end of the study period (7.5
vs 8.9 pills, respectively). No major adverse reactions were noted in either group.
Conclusions
Exparel use was found to result in decreased pain and opioid consumption only on the
day of surgery and not thereafter.
Type of study/level of evidence
Therapeutic II.
Key words
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Article info
Publication history
Published online: September 29, 2017
Accepted:
August 22,
2017
Received:
January 6,
2017
Footnotes
The study was supported by an unrestricted educational grant from Pacira Pharmaceuticals Inc.
Identification
Copyright
© 2017 by the American Society for Surgery of the Hand. All rights reserved.
