T. DiNitto1, D. Hill1, K. Khariton1, M. Castellano1 1Staten Island University Hospital,Northwell Health,Staten Island, NY, USA
Introduction:
Prescription narcotic misuse is an epidemic in the United States. This study set out to examine whether liposomal bupivacaine (Exparel), 0.25% bupivacaine (Marcaine), or 1% lidocaine with epinephrine mixed with 0.25% bupivacaine would decrease the postoperative use of narcotics in ambulatory hernioplasty.
Methods:
A single surgeon performed 427 consecutive tension-free plug and patch mesh hernia repairs under local anesthesia with IV sedation from April 1, 2015 to December 31, 2015. Hernia repairs included inguinal, ventral, incisional, and umbilical. In 9.3% of cases two hernias were repaired during the same procedure. Every patient was seen between six and eleven days post hernioplasty and a standardized pain questionnaire was completed regarding subjective pain, prescription “painkiller”, and over the counter pain medication use in both quantity and duration. The primary endpoint was percentage of patients not requiring narcotics for pain control.
Results:
The Exparel group (147) and the Marcaine group (144) had similar results at 59% and 55% of patients who were able to avoid postoperative narcotics completely. The commonly used lidocaine with epinephrine/Marcaine mixture had only 39% success rate, significantly lower than the other groups. Included in the study were patients that had two simultaneous hernia repairs where the exparel group only had 5.4% with 14% in the Marcaine.
Conclusion:
Our study demonstrates Exparel and Marcaine performed similarly reducing the need of postoperative narcotic use in outpatient hernia surgery by over 50%. Both were a considerably better option than the Lidocaine/Marcaine mixture. The average cost difference between Exparel and Marcaine is exponential, with a difference of over 200 dollars per patient. Marcaine provides a significant cost benefit while achieving similar if not better postoperative pain relief and reduces postoperative narcotic use. Because of the similar outcome in pain control as well as the cost benefit, Marcaine has become the standard of care in our hernia center.
