Department of cardiovascular diseases, Mayo Clinic Rochester, Rochester, Minnesota, USA.
Mayo Clinic Arizona, Phoenix, Arizona, USA.
Pacing Clin Electrophysiol. 2021 Mar;44(3):513-518. doi: 10.1111/pace.14175. Epub 2021 Feb 3.
The subcutaneous implantable cardioverter-defibrillator (S-ICD) has a larger generator and its implantation involves more dissection and tunneling compared to traditional transvenous defibrillator system. Liposomal bupivacaine, an extended-release bupivacaine with 72 h of duration has been used for postoperative pain management in patients undergoing S-ICD implantation. Our aim was to compare postoperative pain and opioid prescription patterns among patients undergoing S-ICD implantation who received intraprocedural liposomal bupivacaine and those who did not.
We performed a retrospective analysis of all patients who underwent subcutaneous ICD implantation from January 1, 2013 to March 30, 2018 at the Mayo Clinic in Rochester, Minnesota. Patients were categorized into those who received liposomal bupivacaine and those who did not. Data on inpatient pain score, outpatient opioid prescription rates at discharge, and doses based on oral morphine equivalents (OME) were collected.
A total of 104 patients underwent S-ICD implantation. Intraprocedural liposomal bupivacaine was used in 69% of patients. Patients who received intraprocedural liposomal bupivacaine had similar mean inpatient pain scores (2.9 vs. 2.9, p = .786). There was also no difference in the rate of inpatient opioid administration (79.2% vs. 87.5%, p = .4139), outpatient opioid prescription (23.6% vs. 12.5%, p = .29), or mean OME (41.7-mg vs. 16.6-mg, p = .188) when comparing patients those who received intraprocedural liposomal bupivacaine and those who did not.
Intraprocedural liposomal bupivacaine administration was not associated with any significant impact on postoperative pain scores, inpatient opioid administration, and outpatient opioid prescription rates or OME amounts at discharge.
与传统经静脉除颤系统相比，皮下植入式心律转复除颤器（S-ICD）的发生器更大，其植入涉及更多的解剖和隧道操作。脂质体布比卡因是一种持续 72 小时的布比卡因延长释放制剂，已用于接受 S-ICD 植入的患者的术后疼痛管理。我们的目的是比较接受和不接受术中脂质体布比卡因的 S-ICD 植入患者的术后疼痛和阿片类药物处方模式。
我们对 2013 年 1 月 1 日至 2018 年 3 月 30 日在明尼苏达州罗切斯特市梅奥诊所接受皮下 ICD 植入的所有患者进行了回顾性分析。患者分为接受脂质体布比卡因和未接受脂质体布比卡因的两组。收集了住院疼痛评分、出院时门诊阿片类药物处方率和基于口服吗啡当量（OME）的剂量数据。
共有 104 例患者接受 S-ICD 植入。69%的患者术中使用了脂质体布比卡因。接受术中脂质体布比卡因的患者住院疼痛评分相似（2.9 对 2.9，p=0.786）。在接受阿片类药物的住院率（79.2%对 87.5%，p=0.4139）、门诊阿片类药物处方率（23.6%对 12.5%，p=0.29）或 OME（41.7-mg 对 16.6-mg，p=0.188）方面，接受和不接受术中脂质体布比卡因的患者之间也没有差异。
术中给予脂质体布比卡因并不会对术后疼痛评分、住院期间阿片类药物的使用以及出院时阿片类药物的处方率或 OME 量产生任何显著影响。
