Alter Todd H, Liss Frederic E, Ilyas Asif M
Rothman Institute at Thomas Jefferson University, Philadelphia, PA.
Rothman Institute at Thomas Jefferson University, Philadelphia, PA.
J Hand Surg Am. 2017 Dec;42(12):1003-1008. doi: 10.1016/j.jhsa.2017.08.022. Epub 2017 Sep 30.
To compare pain experience and opioid use after distal radius fracture repair surgery performed with perioperative infiltration of the local anesthesia bupivacaine hydrochloride (Marcaine; Pfizer, New York, NY) or bupivacaine liposome (Exparel; Pacira, Parsippany, NJ).
We conducted a prospective comparison of consecutive patients scheduled to undergo distal radius fracture repair surgery. Patients were randomized to either Marcaine or Exparel. Patients in the Marcaine group received 20 mL 0.5% bupivacaine without epinephrine into the incision and surgical site before incision. Patients in the Exparel group first received 10 mL 0.5% Marcaine with no epinephrine into the incision and surgical site before incision; then, upon completion of the surgery and wound closure, they also received 10 mL Exparel into the same site that had been preinjected with Marcaine. All operations were performed with the same surgical technique. Daily opioid pill consumption, pain levels, and any adverse reactions were recorded from postoperative days 0 to 5.
On the day of surgery, patients in the Exparel group reported significantly lower pain levels (3.9 vs 5.8) and consumed significantly fewer prescribed opioid pills (1.2 vs 2.0) compared with patients in the Marcaine group. However, there were no other significant differences between the Exparel and Marcaine groups on any subsequent days or in the total number of pills consumed at the end of the study period (7.5 vs 8.9 pills, respectively). No major adverse reactions were noted in either group.
Exparel use was found to result in decreased pain and opioid consumption only on the day of surgery and not thereafter.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.
比较在桡骨远端骨折修复手术中，围手术期局部麻醉使用盐酸布比卡因（耐乐品；辉瑞公司，纽约，纽约州）或布比卡因脂质体（Exparel；Pacira公司，帕西帕尼，新泽西州）后的疼痛体验和阿片类药物使用情况。
我们对计划接受桡骨远端骨折修复手术的连续患者进行了前瞻性比较。患者被随机分为耐乐品组或Exparel组。耐乐品组患者在切开前于切口和手术部位注射20毫升0.5%不含肾上腺素的布比卡因。Exparel组患者在切开前于切口和手术部位先注射10毫升0.5%不含肾上腺素的耐乐品；然后，在手术完成和伤口缝合后，他们还在预先注射耐乐品的同一部位注射10毫升Exparel。所有手术均采用相同的手术技术。记录术后0至5天每日阿片类药物丸剂的消耗量、疼痛程度以及任何不良反应。
与耐乐品组患者相比，Exparel组患者在手术当天报告的疼痛程度显著更低（3.9比5.8），并且服用的处方阿片类药物丸剂显著更少（1.2比2.0）。然而，在随后的任何一天，Exparel组和耐乐品组之间没有其他显著差异，在研究期结束时消耗药丸的总数也没有显著差异（分别为7.5丸和8.9丸）。两组均未观察到重大不良反应。
发现使用Exparel仅在手术当天导致疼痛减轻和阿片类药物消耗量减少，而非在此之后。
研究类型/证据水平：治疗性II级。
