INTRODUCTION: Liposomal bupivacaine (LB) is a long-acting local anesthetic that has become a valuable tool in multimodal pain therapy for many adult surgical specialties. However, it has only recently been used in the pediatric population. Recent studies have shown that administration of LB in pediatric patients is safe and efficacious, particularly in the craniofacial population. Despite this, there has not been a study focusing on its use in alveolar cleft patients. We proposed that the use of surgical site infiltration with LB in this population would be associated with a decrease in postoperative opioid requirements following alveolar bone grafting.
MATERIALS AND METHODS: A retrospective cohort study was conducted that included patients who underwent alveolar bone grafting from November 2016 to December 2018 by 2 craniofacial surgeons at a tertiary craniofacial center. Data collected included technique of harvest (H-osteotomy, trap door osteotomy, and coring drill), laterality (left, right, or bilateral), demographics, and the use of LB. We then calculated the total opioid use through the end of postoperative day (POD) 1. All opioid amounts were corrected for patient weight and converted to an oral morphine equivalent (OME) for standardization. We then performed a multivariable linear regression modeling OME as a function of LB use while controlling for operative technique, laterality, age, sex, and weight.
RESULTS: Forty-four patients who underwent alveolar bone grafting (29 female and 17 male, ages 8–17 years with median age 11 years) were included in our study. Two of the 44 patients underwent separate right and left ABG operations for a total of 46 charted hospital admissions. The H osteotomy harvesting technique was used 23 times (53.3%), trap door osteotomy technique 13 times (29.5%), and the coring drill technique 10 times (22.7%). Eighteen (39.1%) patients used intravenous narcotics, 18 (39.1%) patients used oral narcotics, and 10 (21.8%) used no narcotics at all. Twenty-five (54.3%) patients received LB. Average hospital length of stay (LOS) was 1.6 days (SD, ±0.63), over which patients received on average 13.0 mg OME (SD, ±13.1 mg) up until the end of POD 1. On multivariable analysis, patients who received LB required 14.4 mg less of OME up until POD 1 (P = 0.007). There was no difference in hospital LOS (1.76 versus 1.4 days; P = 0.83) or number of postoperative visits within 30 days following surgery (2.1 versus 1.8; P = 0.09) between cohorts. Patients who underwent bilateral bone grafting had a longer LOS (1.5 versus 0.9; P = 0.0183). The LB cohort had reduced proportion of patients requiring intravenous narcotics (28% versus 52.4%) and oral narcotics (36% versus 42.8%) and had a higher proportion of patients who received no narcotics (36% versus 4.8%) (P = 0.027). LB use was not associated with overall hospital costs ($35,211 versus $36,622; P = 0.68).
CONCLUSIONS: Intraoperative surgical site infiltration of LB was associated with decreased postoperative opioid requirements following alveolar bone grafting. It can be an effective part of multimodal pain therapy in the pediatric population. Further studies will need to be conducted focusing on the association of LB on LOS and decreasing hospital cost.