Keller Deborah S, Pedraza Rodrigo, Tahilramani Reena N, Flores-Gonzalez Juan R, Ibarra Sergio, Haas Eric M
Colorectal Surgical Associates, Houston, TX, USA; Department of Surgery, Houston Methodist Hospital, Houston, TX, USA.
Department of Surgery, University of Texas Medical School at Houston, Houston, TX, USA.
Am J Surg. 2017 Jul;214(1):53-58. doi: 10.1016/j.amjsurg.2015.10.035. Epub 2016 Feb 27.
Our objective was to assess clinical and financial outcomes with long-acting liposomal bupicavaine (LB) in laparoscopic colorectal surgery.
Patients that received local infiltration with LB were strictly matched to a control group, and compared for postoperative pain, opioid use, length of stay (LOS), hospital costs, and complication, readmission, and reoperation rates.
A total of 70 patients were evaluated in each cohort. Operative times and conversion rates were similar. LB patients had lower post-anesthesia care unit pain scores (P = .001) and used less opioids through postoperative day 3 (day 0 P < .01; day 1 P = .03; day 2 P = .02; day 3 P < .01). Daily pain scores were comparable. LB had shorter LOS (mean 2.96 vs 3.93 days; P = .003) and trended toward lower readmission, complication, and reoperation rates. Total costs/patient were $746 less with LB, a savings of $52,200 across the cohort.
Using local wound infiltration with LB, opioid use, LOS, and costs were improved after laparoscopic colorectal surgery. The additional medication cost was overshadowed by the overall cost benefits. Incorporating LB into a multimodal pain regiment had a benefit on patient outcomes and health care utilization.
我们的目标是评估长效脂质体布比卡因（LB）在腹腔镜结直肠手术中的临床和经济结果。
接受LB局部浸润的患者与对照组进行严格匹配，比较术后疼痛、阿片类药物使用情况、住院时间（LOS）、住院费用以及并发症、再入院和再次手术率。
每个队列共评估了70例患者。手术时间和转换率相似。LB组患者在麻醉后护理单元的疼痛评分较低（P = 0.001），并且在术后第3天使用的阿片类药物较少（第0天P < 0.01；第1天P = 0.03；第2天P = 0.02；第3天P < 0.01）。每日疼痛评分相当。LB组的住院时间较短（平均2.96天对3.93天；P = 0.003），再入院、并发症和再次手术率有降低趋势。LB组每位患者的总成本减少了746美元，整个队列节省了52,200美元。
在腹腔镜结直肠手术后，使用LB进行局部伤口浸润可改善阿片类药物使用、住院时间和成本。额外的药物成本被总体成本效益所掩盖。将LB纳入多模式疼痛治疗方案对患者预后和医疗保健利用有益。
