Bupivacaine Versus Liposome Bupivacaine (EXPAREL®) for Postoperative Pain Control after Augmentation Mammaplasty: A Prospective Double Blinded Randomized Clinical Trial

Goals/Purpose: There is a newly available long acting preparation of bupivacaine, liposome bupivacaine (EXPAREL®), which has been shown to be safe in breast augmentation. It remains to be established if liposome bupivacaine provides superior pain control in this setting.This study compares liposome bupivacaine and standard bupivacaine for postoperative pain control. The secondary endpoint is cost justification.

Methods/Technique: Thirty-four patients undergoing cosmetic primary subpectoral breast augmentation were recruited for this double-blinded prospective randomized clinical trial.. Each patient was treated with bupivacaine in one implant pocket and liposome bupivacaine in the other prior to closure in a randomized fashion. Both patient and surgeon were blinded. A brief pain inventory was administered by telephone every 12 hours up to 72 hours postoperatively.

Results/Complications:

Liposome bupivacaine demonstrated a statistically significantly lower pain score at the 12, 36, 48, and 60 hour time points in the worst pain category; at the 24, 36, 48, and 60 hour time points in the least pain category; and at the 12, 24, 36, 48, 60, and 72 hour time points in the average pain category. These differences, however, were small, ranging from 0.39-1 using a 10 point pain scale.  When asked if the additional charge for the liposome bupivacaine would have been worth the benefit, 70% of the patients said “no”.

Conclusion: Although there is a statistically significant decrease in postoperative pain with the use of liposome bupivacaine, this may not translate to an appreciable clinical benefit that justifies 248 times the cost.