Exparel Reduces Perioperative Pain and Opioid Use after Rhinoplasty: A Single Institution Retrospective Cohort.

Goals/Purpose: Every day, an average of 130 Americans die from opioid overdose. This number has increased 6-fold in the last two decades. Up to 10% of opioid naïve patients will continue to take their prescribed postoperative opioid one year after surgery. Exploring alternatives to opioid while maintaining patient safety and comfort is crucial. The use of long-lasting local anesthetics like liposomal bupivacaine (Exparel) has emerged as a promising alternative to reduce opioid use. We conducted this study in aims of understanding the relationship between the use of liposomal bupivacaine (Exparel) in rhinoplasties and postoperative opioid use as well as patient comfort.

Methods/Technique: An institutional retrospective review was performed to identify consecutive patients who underwent rhinoplasty at our institution from June of 2018 to August of 2020. Only patients who underwent aesthetic rhinoplasty were included. Patients with additional aesthetic procedures and patients who underwent cartilage harvest were excluded. Patients were divided based on the use of Exparel versus traditional local anesthesia only (lidocaine with epinephrine). Demographic data, perioperative pain medications and post-operative pain was recorded. Post-operative pain was recorded after recovering from anesthesia at 30 mins, 2 hrs. and 4 hrs., 8hrs, 12hrs, 16hrs, 24hrs, using the numeric intensity pain scale which range from 1 to 10. Data regarding additional pain medications received to achieve adequate pain control was collected and compared amongst the groups. Comparative analysis of continuous variables and categorical variables were performed using the Mann-Whitney-Wilcoxon and Fisher’s exact tests, respectively. A value of p < 0.05 was considered statistically significant.

Results/Complications: A total of 97 consecutive patients were identified and included in this study. Of them, 24 used Exparel and 73 used lidocaine with epinephrine. There was no difference in age, sex or ethnicity of the patients. Mean postoperative pain score in the first 30 minutes of evaluation was significantly lower in the Exparel group than in the group whit lidocaine and epinephrine (1.4 vs 3.6; p=0.0002). In order to achieve adequate pain control, patients in the lidocaine with epinephrine group required opioid medications more frequently (56.8%) than patients in the Exparel group (33.3%; p=0.0461). Overall, the average of all pain scores during hospitalization was significantly lower in the Exparel group (2.0) than in the lidocaine with epinephrine group (3.2; p=0.0105).

Conclusion: Exparel helps reduce postoperative pain and decrease the amount of opioid medication needed to achieve adequate pain control in rhinoplasty patients