Amin Dina, Conner Drake, Umorin Mikhail, Bouloux Gary F
Associate Professor, Residency Program Director, Department of Oral and Maxillofacial Surgery, University of Rochester, Rochester, NY.
Resident-in-training, Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA.
J Oral Maxillofac Surg. 2024 May;82(5):538-545. doi: 10.1016/j.joms.2024.01.016. Epub 2024 Feb 2.
Poorly controlled postoperative pain results in prolonged length of stay (LOS). The use of liposome bupivacaine injectable suspension (LB) for postoperative pain control is a relatively recent practice.
The purpose of this study was to investigate the following. In patients undergoing open reduction and internal fixation of mandibular fracture(s), does the use of LB reduce LOS compared with regular bupivacaine?
STUDY DESIGN, SETTING, SAMPLE: We implemented a retrospective cohort study of consecutive patients with mandibular fracture(s) presented to Grady Memorial Hospital in Atlanta, GA, from January 2021 to January 2022. Adult patients diagnosed with 1 or more isolated mandibular fracture(s) and treated by open reduction and internal fixation were included. We excluded patients with non-isolated mandibular fracture(s), isolated condyle, infected, previously treated fractures, and documented allergy to amide local anesthetics and/or its preservatives.
PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE: Primary predictor variable was local anesthetic (regular bupivacaine alone or LB/regular bupivacaine).
MAIN OUTCOME VARIABLE(S): Primary outcome variable was LOS, defined as the number of days from surgical procedure until discharge. Secondary outcome variables were number of opioid prescription refill(s) and postoperative pain at discharge, determined with visual analogue scale.
The covariates were Demographics, American Society of Anesthesiologists classification, smoking, alcohol exposure, illicit drug use, etiology, location, laterality, number of fracture(s), surgical approach, and method of maxillomandibular fixation.
Univariate and bivariate analyses were calculated. Statistical significance was P < .05.
Sixty-two subjects met the inclusion criteria (31 subjects in each group). The mean ages in LB/regular bupivacaine and regular bupivacaine alone groups were 33.3 (±12) and 35.1 (±15.6), respectively (P = .94), the mean LOS in days was 0.23 (±0.44) in LB/regular bupivacaine and 1.48 (±1.77) in regular bupivacaine alone (P= < .001), and the mean VAS pain scores for LB/regular bupivacaine and regular bupivacaine alone groups were 0.53 (±1.07) and 1.87 (±2.66), respectively (P = .02). Mean number of opioid prescription refill(s) was 0 in LB/regular bupivacaine and 1 in regular bupivacaine alone group, respectively (P = .01).
The use of LB/regular bupivacaine for mandibular fracture(s) results in decrease in LOS and number of opioid refills compared to regular bupivacaine alone.
术后疼痛控制不佳会导致住院时间延长。使用脂质体布比卡因注射用混悬液（LB）控制术后疼痛是一种相对较新的做法。
本研究的目的是调查以下内容。在下颌骨骨折切开复位内固定患者中，与普通布比卡因相比，使用LB是否能缩短住院时间？
研究设计、设置、样本：我们对2021年1月至2022年1月在佐治亚州亚特兰大市格雷迪纪念医院就诊的连续下颌骨骨折患者进行了一项回顾性队列研究。纳入诊断为1处或多处孤立下颌骨骨折并接受切开复位内固定治疗的成年患者。我们排除了非孤立下颌骨骨折、孤立髁突骨折、感染性骨折、既往接受过治疗的骨折以及记录有对酰胺类局部麻醉药和/或其防腐剂过敏的患者。
预测因素/暴露因素/独立变量：主要预测变量是局部麻醉药（仅普通布比卡因或LB/普通布比卡因）。
主要结局变量是住院时间，定义为从手术到出院的天数。次要结局变量是阿片类药物处方再填充次数和出院时的术后疼痛，通过视觉模拟量表确定。
协变量包括人口统计学特征、美国麻醉医师协会分级、吸烟、饮酒、非法药物使用、病因、骨折部位、骨折侧别、骨折数量、手术入路以及颌间固定方法。
进行单变量和双变量分析。统计学显著性为P < 0.05。
62名受试者符合纳入标准（每组31名受试者）。LB/普通布比卡因组和仅普通布比卡因组的平均年龄分别为33.3（±12）岁和35.1（±15.6）岁（P = 0.94），LB/普通布比卡因组的平均住院天数为0.23（±0.44）天，仅普通布比卡因组为1.48（±1.77）天（P < 0.001），LB/普通布比卡因组和仅普通布比卡因组的平均视觉模拟量表疼痛评分分别为0.53（±1.07）和1.87（±2.66）（P = 0.02）。LB/普通布比卡因组的阿片类药物处方平均再填充次数为0次，仅普通布比卡因组为1次（P = 0.01）。
与仅使用普通布比卡因相比，使用LB/普通布比卡因治疗下颌骨骨折可缩短住院时间并减少阿片类药物再填充次数。
