Use of Regional Block Injections with Liposomal Bupivicaine to Control Postoperative Pain after Breast Augmentation
Methods/Technique: In a randomized, single center, double-blinded, active-control trial, 40 female patients underwent primary submuscular breast augmentation. All procedures were performed in the same surgical outpatient center, by four surgeons. All patients were women, of age 18 or older, and underwent primary, bilateral, cosmetic, subpectoral breast augmentation under general anesthesia. Forty eight patients were randomized and enrolled in the study. Eight patients could not be contacted for follow up per protocol and were subsequently excluded. Patients and the study coordinator were blinded to the product administration. Twenty patients received liposomal bupivicaine injections, and twenty patients received 0.5% bupivicaine with epinephrine injections in an regional block fashion. Patient age, height, and weight were recorded. Pain scores, pain pills used, and activity level was evaluated at the third postoperative day.
Results/Complications: The average age was 30. The average patient BMI was 22kg/m2. The average total oral pain pills required at the third postoperative day was 15 pills for the 0.5% bupivicaine group, and 9 pills for the liposomal bupivicaine group (p= 0.00598). The average pain score for both groups was 3.8, and 2.65, respectively (p= 0.053). The average day for resumption of normal activity was 3.1 for both groups. No serious adverse events occurred, and no patients discontinued the study due to adverse events.
Conclusion: In this study, liposomal bupivicaine injections for regional blocks in primary submuscular breast augmentation indicate that patients require less postoperative narcotics and had less postoperative pain within the first three days after surgery. However, there was no significant difference in resumption of normal activity. In conclusion, liposomal bupivicaine is effective in reducing postoperative pain after primary submuscular breast augmentation. Further investigation is warranted with more clinical cases in order to recommend the use of this medication for routine pain management after submuscular breast augmentation.