TITLE:
Use of Liposomal Bupivacaine (Exparel) for Reduction in the Use of Postoperative Narcotics in an Obese Patient Undergoing Modified Radical Mastectomy
AUTHORS:
Charles Keilin, Evan P. Salant, Charusheela Andaz, Reet Lawhon, Piyush Gupta, Dennis E. Feierman
KEYWORDS:
Liposomal Bupivacaine, Exparel, Narcotic Sparing
JOURNAL NAME:
Open Journal of Anesthesiology,
Vol.5 No.6,
June
9,
2015
ABSTRACT: Background: Obesity, particularly in the setting of comorbid disease, presents a unique challenge. Clinicians are pursuing areas of multimodal analgesia in an effort to minimize narcotic dosages. Post-operatively, their pain management can be even more challenging, which includes appropriate use of narcotics in a patient that has a high probably of sleep apnea. Aim: To show that the use of liposomal bupivacaine (Exparel) can provide effective post-operative pain relief and decrease the use of post-operative narcotics. Case: We report on a 62 years old female with a history of hypertension, obesity and a greater than a 40 pack year history of smoking who presented for a modified radical mastectomy with a lymph node dissection. At the end of the case, the patient’s wound was infiltrated with both free bupivacaine and Exparel that minimized her need for post-operative narcotics. Conclusion: We believe that the use of extended release local anesthetics should be considered when there is a need to reduce the use of post-operative narcotics.