Thoracic Epidurals are Associated With Decreased Opioid Consumption Compared to Surgical Infiltration of Liposomal Bupivacaine Following Video-Assisted Thoracoscopic Surgery for Lobectomy: A Retrospective Cohort Analysis

Journal of Cardiothoracic and Vascular Anesthesia
Jacklynn F SztainEngy T Said

Abstract

Thoracic epidural analgesia (TEA) is considered the gold standard for postoperative pain control in thoracic surgery, however it is associated with the undesirable risks of hypotension urinary retention, and bleeding. Recently, surgical site infiltration with liposomal bupivicaine (LB) has been suggested as a comparable alternative to TEA. The authors compared total opioid consumption in patients who received either TEA or LB undergoing video-assisted thorascopic surgery (VATS) for lobectomy. Retrospective cohort study. University hospital. Patients undergoing VATS for lobectomy. TEA versus LB MEASUREMENTS AND MAIN RESULTS: The primary outcome was POD 0 to 2 total opioid requirements, measured in intravenous morphine equivalents (mg). Wilcoxon rank sum test was used to calculate the significant differences in the primary outcome. The 25 - 75% interquartile range (IQR) was reported with each median value. Forty-five patients were included in the analysis, in which 14 (31.1%) were in the LB group. Between the TEA and LB group, there were no differences in age, sex, or body mass. The median (25 - 75% IQR) total opioid consumption during POD 0 - 2 in the TEA and LB group were 28.0 mg (12.0 - 52.0 mg) and 49.5 mg (35.0 - 70.5 mg), r...Continue Reading

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