Does Liposomal Bupivicaine Injection Decrease Postoperative Opioid Usage following Bimaxillary Surgery?

Purpose Among patients undergoing bimaxillary surgery, does the use of liposomal bupivacaine injection reduce the use of opioid analgesics and/or length of hospital admission in the postoperative period? Methods A retrospective cohort analysis was conducted on subjects who received orthognathic surgery from 2017 to 2019 at Parkland Memorial Hospital. Inclusion criteria were a maxillary Le Fort I procedure and simultaneous bilateral sagittal split osteotomy. Exclusion criteria were a syndromic condition, repeat surgery, concomitant genioplasty or temporomandibular joint surgery, or single-jaw surgery. The predictor variable was the administration of a standard dosage of 266mg (20mL) of liposomal bupivacaine distributed equally among all 4 surgical sites. The primary outcome variable was the total milligram morphine equivalent (MME) of opioids administered to the subject in the immediate postoperative period. Secondary predictor variables were postoperative hospital stay length, defined in days, age, and sex, defined as male or female. Statistical analysis was performed with P < .05 used to determine statistical significance. Results Nineteen patients met the defined inclusion criteria. The age at the time of surgery ranged from 17 to 51, with the average age being 26 years old. The cohort consisted of 8 males and 11 females. Ten subjects received an injection of 266mg of liposomal bupivacaine, divided equally among all 4 surgical sites (2 maxillary and 2 mandibular) at the completion of surgery, and 9 subjects received no liposomal bupivacaine. Postoperatively, subjects received varying combinations of PRN opioids, including: codeine, hydrocodone, oxycodone, fentanyl, and hydromorphone. MME for each of these medications was then calculated. Patients in the group who received a liposomal bupivacaine injection required a mean of 9.3 MME during their postoperative course, while the group who did not receive liposomal bupivacaine required a mean of 25 MME. Statistical analysis revealed a significant difference in MME usage between the 2 groups (P =.0243). The average postoperative hospital admission duration was 1.32 days, with no significant difference between the 2 study groups (P = .884). There was no significant difference between sex or age and postoperative MME usage (P = .566 and P = .381, respectively). Discussion Management of postoperative pain is not only vital to patients’ surgical experiences, but is imperative in preserving hospital resources, decreasing hospital stay, and decreasing readmission rates. In total, 20-80% of patients experience moderate to severe pain during their postoperative course. Opioids remain the leading modality to manage postoperative pain, but the recent opioid epidemic has motivated clinicians to pursue other pathways, including liposomal bupivacaine for pain management to mitigate the use of large doses of opioids. The results of the present study suggest that administration of 266mg of liposomal bupivacaine, given equally in all 4 surgical sites following bilateral Le Fort I and sagittal split osteotomies, leads to a statistically significant decrease in postoperative opioid usage. Future prospective studies utilizing liposomal bupivacaine and standard multimodal pain control regimens following orthognathic procedures will further explore the efficacy of liposomal bupivacaine in opioid reduction and management of postsurgical pain.