Vyas Krishna S, Rajendran Sibi, Morrison Shane D, Shakir Afaaf, Mardini Samir, Lemaine Valerie, Nahabedian Maurice Y, Baker Stephen B, Rinker Brian D, Vasconez Henry C
Lexington, Ky.; Seattle, Wash.; Palo Alto, Calif.; Rochester, Minn.; and Washington, D.C.
From the Division of Plastic Surgery, Department of Surgery, University of Kentucky College of Medicine; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington Medical Center; Stanford University School of Medicine; the Division of Plastic Surgery, Department of Surgery, Mayo Clinic; and the Department of Plastic Surgery, Georgetown University Hospital.
Plast Reconstr Surg. 2016 Oct;138(4):748e-756e. doi: 10.1097/PRS.0000000000002547.
Management of postoperative pain often requires multimodal approaches. Suboptimal dosages of current therapies can leave patients experiencing periods of insufficient analgesia, often requiring rescue therapy. With absence of a validated and standardized approach to pain management, further refinement of treatment protocols and targeted therapeutics is needed. Liposomal bupivacaine (Exparel) is a longer acting form of traditional bupivacaine that delivers the drug by means of a multivesicular liposomal system. The effectiveness of liposomal bupivacaine has not been systematically analyzed relative to conventional treatments in plastic surgery.
A comprehensive literature search of the MEDLINE, PubMed, and Google Scholar databases was conducted for studies published through October of 2015 with search terms related to liposomal bupivacaine and filtered for relevance to postoperative pain control in plastic surgery. Data on techniques, outcomes, complications, and patient satisfaction were collected.
A total of eight articles were selected and reviewed from 160 identified. Articles covered a variety of techniques using liposomal bupivacaine for postoperative pain management. Four hundred five patients underwent procedures (including breast reconstruction, augmentation mammaplasty, abdominal wall reconstruction, mastectomy, and abdominoplasty) where pain was managed with liposomal bupivacaine and compared with those receiving traditional pain management. Liposomal bupivacaine use showed adequate safety and tolerability and, compared to traditional protocols, was equivalent or more effective in postoperative pain management.
Liposomal bupivacaine is a safe method for postoperative pain control in the setting of plastic surgery and may represent an alternative to more invasive pain management systems such as patient-controlled analgesia, epidurals, peripheral nerve catheters, or intravenous narcotics.
术后疼痛管理通常需要采用多模式方法。当前治疗方法的剂量不足会使患者经历镇痛不足的时期，常常需要进行补救治疗。由于缺乏经过验证的标准化疼痛管理方法，因此需要进一步完善治疗方案并研发针对性的治疗方法。脂质体布比卡因（Exparel）是传统布比卡因的一种长效剂型，它通过多泡脂质体系统输送药物。相对于整形外科的传统治疗方法，脂质体布比卡因的有效性尚未得到系统分析。
对MEDLINE、PubMed和谷歌学术数据库进行了全面的文献检索，以查找截至2015年10月发表的与脂质体布比卡因相关的研究，并筛选出与整形外科术后疼痛控制相关的研究。收集了有关技术、结果、并发症和患者满意度的数据。
从160篇已识别的文章中总共筛选并审阅了8篇文章。这些文章涵盖了使用脂质体布比卡因进行术后疼痛管理的各种技术。405例患者接受了使用脂质体布比卡因进行疼痛管理的手术（包括乳房重建、隆乳术、腹壁重建、乳房切除术和腹壁成形术），并与接受传统疼痛管理的患者进行了比较。使用脂质体布比卡因显示出足够的安全性和耐受性，并且与传统方案相比，在术后疼痛管理方面等效或更有效。
脂质体布比卡因是整形外科术后疼痛控制的一种安全方法，可能是患者自控镇痛、硬膜外麻醉、外周神经导管或静脉麻醉等侵入性更强的疼痛管理系统的替代方法。
