D. G. McKeown1, C. Sokas1, A. Nevler1, S. Goldstein1, G. Isenberg1, B. Phillips1 1Thomas Jefferson University Hospital,Colorectal Surgery,Philadelphia, PA, USA
Introduction:
Our objective was to assess the clinical efficacy of Liposomal Bupivacaine (LB) in patients undergoing ileostomy and colostomy reversal and its effect on average length of stay
Methods:
We conducted a single institution retrospective review of consecutive patients undergoing elective reversal and closure of either an ileostomy or colostomy from January 2012 to December 2016. Liposomal bupivacaine was approved for use at our institution between May 2013 to September 2016. The primary outcomes were postoperative hospital length of stay (LOS) and cumulative opioid usage calculated as morphine equivalents (MEQ)
Results:
A total of 154 patients were evaluated. 87 patients received LP and 67 patients received a standard dose of local anesthetic. There was no significant difference between the two cohorts. The mean length of stay for the non-LB group was 4.27 days compared to 3.45 days in the LB group (p=0.009). We then defined early discharge as a discharge less or equal to three days and we found that patients who received LB were more likely to receive an early discharge with an odds ratio of 2.1 (CI 1.13 – 4.13) p=0.23. Cumulative opioid use 78.8 morphine equivalents (meq) in the non-LB group versus 75.7 in the LP group (p=0.66). 32.8% of the LP group received a PCA vs 25.3% of the non-LBA group and there was no statistical difference in LOS between these two groups (p=0.36) Secondary outcomes looked at the effect of non-opioid analgesia and anti-emetics on length of stay. When we examined anti-emetic usage, we noted that patients who did not require the administration of anti-emetics were more likely to be discharged early (p=0.05, OR = 0.37 (CI = 0.19 – 0.72))
Conclusion:
The usage of LB for local wound anesthesia after colostomy and ileostomy reversal is associated with decreased LOS, however opioid usage between the non-LB and LB groups were similar. Despite this, LB appears to offer the benefit of decreasing costs associated with longer hospital stay. A multi-institutional prospective randomized control trial would help to elucidate further.
