Retrospective Study of Liposomal Bupivacaine for Pectus Excavatum Repair

Aim: The aim of this study is to assess whether Exparel (bupivacaine liposome injectable suspension, Pacira BioSiences, Inc., Parsippany, NJ) is superior to plain bupivacaine. Objectives: The objective of the study is to ascertain retrospectively whether Exparel use in patients undergoing surgical correction of pectus excavatum is effective in providing post-operative analgesia when compared to plain bupivacaine. Methods: 72 pediatric patients (36 in each group) undergoing surgical repair of pectus excavatum were included in this study. There were 36 patients in the liposomal bupivacaine (LB) group and 36 patients in the plain bupivacaine group. We compared the two groups for Morphine equivalent usage, adjuvant analgesic usage, pain scores, and length of stay. Results: The group that received the liposomal bupivacaine had lower morphine equivalent usage (1.75 mg/kg vs. 4.13 mg/kg, p-value=0.002), lower pain scores after 24 hours (p-value<0.001) and shorter length of stay (2.54 days vs 3.54 days, p-value=0.00002) compared to the group that just received plain bupivacaine. The total amount of bupivacaine did vary between groups (2.0 mg/kg vs. 1.4 mg/kg, p<0.001) as did the total volume of injectate (1.13 mL/kg vs. 0.33 mL/mg, p=0.008). No other variables were different. Conclusions: Liposomal bupivacaine appeared superior to bupivacaine hydrochloride for providing post-operative analgesia for patients undergoing pectus bar repair.