Research Assistant, Department of Oral & Maxillofacial Surgery, Thomas Jefferson University, Philadelphia, PA.
Resident, Department of Oral & Maxillofacial Surgery, Thomas Jefferson University, Philadelphia, PA.
J Oral Maxillofac Surg. 2023 Nov;81(11):1336-1343. doi: 10.1016/j.joms.2023.08.002. Epub 2023 Aug 9.
Liposomal bupivacaine (LB) is a long-acting local anesthetic used for postsurgical analgesia to reduce pain and the need for opioid pain medication.
The purpose of this study was to assess patient interest in the use of LB as an alternative to opioid pain medication following third molar extraction.
STUDY DESIGN, SETTING, SAMPLE: A cross-sectional, questionnaire-based study was performed. Study subjects included patients 17 years old or greater who presented to the Oral and Maxillofacial Surgery clinic at Thomas Jefferson University for third molar extraction from May 2019 through January 2020.
The primary outcome variable was patient interest in LB, defined by "yes" or "no" from the survey question: "would you be interested in an alternative medication administered during the procedure that may decrease the need for opioid pain medication?". The secondary outcome variable was patient willingness to pay (WTP) for LB, defined by the out-of-pocket cost threshold patients reported they would pay.
Covariates included patient demographics, attitudes towards opioid medication, and prior opioid use.
Data were analyzed using descriptive statistics, Fisher's exact test, Kruskal-Wallis and Dunn's tests, Kendall's tau correlation, and multivariable logistic regression. Statistical significance was set at P value < .05.
A total of 183 subjects completed the study (68% female, 32% male). The mean age was 27.5 years ± 11.1 years. Most subjects (76%) were interested in LB, but 88% had a WTP threshold below $200. Interest in LB was associated with higher WTP thresholds (adjusted odds ratio {aOR} 2.07; 95% confidence interval {CI} [1.48, 3.13]; P < .001). There was also an association between interest and subjects concerned of the addictive potential of opioids (aOR 4.04; 95% CI [1.52, 11.49]; P = .01) and between interest and previous use of prescribed opioid medication (aOR 6.00; 95% CI [1.59, 31.23]; P = .02).
Although most subjects were interested in LB, the current out-of-pocket cost of LB appears to be a barrier to patient acceptability. A lower cost option may increase the accessibility and adoption of this nonopioid analgesic for postoperative pain control in third molar extractions.
脂质体布比卡因（LB）是一种长效局部麻醉剂，用于术后镇痛，以减少疼痛和对阿片类止痛药的需求。
本研究旨在评估患者对 LB 的使用兴趣，作为第三磨牙拔除术后替代阿片类止痛药的选择。
研究设计、地点和样本：这是一项横断面、基于问卷的研究。研究对象包括 2019 年 5 月至 2020 年 1 月期间在托马斯杰斐逊大学口腔颌面外科诊所就诊的年龄在 17 岁及以上的第三磨牙拔除患者。
主要结局变量是患者对 LB 的兴趣，通过调查问题中的“是”或“否”来定义：“您是否有兴趣在手术过程中使用一种替代药物，该药物可能会减少对阿片类止痛药的需求？”。次要结局变量是患者对 LB 的支付意愿（WTP），由患者报告的他们愿意支付的自付费用阈值来定义。
协变量包括患者人口统计学特征、对阿片类药物的态度和既往阿片类药物使用情况。
使用描述性统计、Fisher 确切检验、Kruskal-Wallis 和 Dunn 检验、Kendall's tau 相关性和多变量逻辑回归进行数据分析。统计学意义设定为 P 值<0.05。
共有 183 名受试者完成了研究（68%为女性，32%为男性）。平均年龄为 27.5 岁±11.1 岁。大多数受试者（76%）对 LB 感兴趣，但 88%的受试者的 WTP 阈值低于 200 美元。对 LB 的兴趣与较高的 WTP 阈值相关（调整后的优势比{aOR}2.07；95%置信区间{CI} [1.48, 3.13]；P<0.001）。对 LB 的兴趣与对阿片类药物成瘾潜力的关注之间也存在关联（调整后的优势比{aOR}4.04；95%置信区间{CI} [1.52, 11.49]；P=0.01），与以前使用处方阿片类药物之间也存在关联（调整后的优势比{aOR}6.00；95%置信区间{CI} [1.59, 31.23]；P=0.02）。
尽管大多数患者对 LB 感兴趣，但目前 LB 的自付费用似乎是患者接受度的一个障碍。降低成本的选择可能会增加这种非阿片类镇痛药在第三磨牙拔除术后疼痛控制中的可及性和采用。
