Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, TX.
Division of Plastic Surgery, Texas Children's Hospital, Houston, TX.
J Craniofac Surg. 2024;35(2):464-468. doi: 10.1097/SCS.0000000000009966. Epub 2024 Jan 15.
Effective pain management is crucial in cleft lip and palate (CLP) patients undergoing orthognathic surgery for earlier recovery and decreased opioid reliance. Liposomal bupivacaine (Exparel) is a local anesthetic that provides extended postoperative analgesia in adult patients; however, research on its use in adolescents is limited. This study explores the efficacy of liposomal bupivacaine for postoperative pain management in adolescent CLP patients undergoing orthognathic surgery.
The authors performed a retrospective chart review at their institution between July 2020 and December 2022 to identify patients who underwent LeFort I or mandibular osteotomy. Two cohorts were compared: patients who received liposomal bupivacaine and patients who received standard pain medications alone. Outcome measures included intraoperative pain medications, length of stay, breakthrough opioid use, time to first oral intake, volume of oral intake, and opioids prescribed at discharge.
This study included 22 patients who underwent orthognathic surgery. The liposomal bupivacaine group (n=10) demonstrated earlier and greater oral intake during hospitalization compared with controls (n=12). The most significant difference was observed in total breakthrough opioid use, with an average of 8.60 morphine milligram equivalents for liposomal bupivacaine patients compared with 35.1 morphine milligram equivalents for controls ( P =0.037).
This study provides the first analysis of liposomal bupivacaine use in adolescent CLP patients undergoing orthognathic surgery, demonstrating a significant reduction in postoperative opioid consumption compared with controls. These results may guide future studies of liposomal bupivacaine within CLP patients, potentially as a component of enhanced recovery after surgery guidelines, as well as in cost-analysis studies.
在接受正颌手术的唇腭裂（CLP）患者中，有效的疼痛管理至关重要，这有助于他们更早地康复并减少对阿片类药物的依赖。脂质体布比卡因（Exparel）是一种局部麻醉剂，可在成年患者中提供延长的术后镇痛效果；然而，其在青少年患者中的应用研究有限。本研究旨在探讨脂质体布比卡因在接受正颌手术的青少年 CLP 患者中用于术后疼痛管理的效果。
作者在机构内进行了回顾性图表审查，时间范围为 2020 年 7 月至 2022 年 12 月，以确定接受 LeFort I 或下颌骨切开术的患者。将两组进行比较：接受脂质体布比卡因的患者和仅接受标准止痛药物的患者。评估的结果包括术中使用的止痛药物、住院时间、阿片类药物突破使用情况、首次口服摄入的时间、口服摄入的量以及出院时开具的阿片类药物。
本研究共纳入 22 名接受正颌手术的患者。与对照组（n=12）相比，接受脂质体布比卡因的患者（n=10）在住院期间更早且更多地进行了口服摄入。两组之间最大的差异体现在阿片类药物突破使用量上，脂质体布比卡因组的平均吗啡等效剂量为 8.60 毫克，而对照组的平均吗啡等效剂量为 35.1 毫克（P=0.037）。
本研究首次分析了脂质体布比卡因在接受正颌手术的青少年 CLP 患者中的应用，结果显示与对照组相比，脂质体布比卡因显著减少了术后阿片类药物的使用。这些结果可能为未来在 CLP 患者中进行脂质体布比卡因研究提供指导，该药物可能成为术后加速康复指南的一部分，也可能为成本分析研究提供参考。
