A single center retrospective matched cohort study comparing efficacy of liposomal bupivacaine and bupivacaine for preincision scalp block in children undergoing craniofacial surgery

BACKGROUND: Liposomal bupivacaine (LB), a long acting local anesthetic has been shown to improve pain control and decrease opioid consumption when locally infiltrated for surgical analgesia. In our institute we used both conventional bupivacaine (BU) and LB for preincision scalp blocks in our craniofacial surgery patient population. We retrospectively analyzed the benefits of the use of LB scalp blocks compared to BU in providing postoperative pain control in pediatric cranioplasty patients.METHODS: This is a retrospective, single center and surgeon, age matched cohort study of pediatric surgical patients undergoing cranial vault remodeling surgery who received preincision scalp block with either LB or BU at Arkansas Children’s Hospital between July 2019 and October 2020. A total of 67 patients met inclusion criteria. Outcome measures included total opioid requirements in weight-based IV morphine milligram equivalents, incidence of postoperative nausea and vomiting from antiemetic dosing requirements, hospital length of stay and documented complications of local anesthetic toxicity. Subjects were matched 1:1 using propensity score optimal matching for age. Postoperative opioid requirements and hospital length of stay were compared between those who received LB and BU using t-test. Postoperative incidence of nausea and vomiting and antiemetic dosing requirements were compared using signed-rank test.RESULTS: A total of 67 surgical cases met inclusion criteria, and 58 were included in the final analysis after matching (29 LB and 29 BU cases). No subjects enrolled had evidence of local anesthetic toxicity. There was no significant difference in number of emesis events between LB and BU groups. For each of the first three postoperative days, the LB group had lower opioid requirements than the BU group. The LB group were also discharged on an average 1.2 days (P=0.0108) earlier than the BU group.CONCLUSIONS: This study showed that single dose of preincision scalp block with LB appears to be safe and associated with decreased opioid requirements in craniofacial surgery patients. More adequately powered trial with optimal matching to correct for confounding factors is needed.