Exparel ® (Bupivacaine Liposome Injectable Suspension) as Adjunctive Pain Control in Adult Tonsillectomy: Reducing Post-Operative Opioid Use

Objectives: To evaluate the effects of using Exparel ® bupivacaine liposome suspension 1.3% (13.3 mg/mL) as an adjunct to standard of care medication in adult tonsillectomy patients. Study Design: Randomized controlled trial. Setting: Community Hospital. Methods: The study arm (n = 22) received Exparel ® bupivacaine liposome suspension 1.3% (13.3 mg/mL) as an adjunct to the standard of care (SOC) medication bupivacaine HCl 0.25% (2.5 mg/mL) with epinephrine (5 μg/mL). The control group (n = 20) received SOC bupivacaine HCl 0.25% with epinephrine (5 μg/mL). All injections were administered after the excision of the tonsil, prior to conclusion of the operative procedure. Pre- and post-operative clinicopathologic variables of interest were collated from electronic medical records and daily pain diaries. Results were analyzed via standard univariate statistics, linear mixed models, and Poisson regression. Results: The Exparel ® + SOC group experienced significantly less pain at post operative day (POD) 3 compared to the control group ( P < .05). Mean pain score decreased on average by 1.23 points in the Exparel ® + SOC group and increased on average by 0.39 points in the control group (adj. P -value < .001). Similarly, analysis showed that maximum pain score decreased on average by 0.64 points in the Exparel ® + SOC and increased on average by 0.61 points the control group (adj. P -value < .001). There was a statistically significant decrease in dose of oxycodone use between POD 3 and POD 5 within the Exparel ® + SOC group (16.39 vs 7.22 mg, P -value = .035). The relative proportion of patients who took oxycodone was less in the Exparel ® + SOC group compared to the control group across all PODs. Conclusion: Use of Exparel ® in adult tonsillectomy may decrease post-operative opioid use compared to standard of care treatment. These findings may serve as guidance for best practices in adult tonsillectomy.