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Liposomal Bupivacaine Local Infiltration for Buccal Mucosal Graft Harvest Site Pain Control: A Single-blinded Randomized Controlled Trial

  • Michael E. Chua
    Affiliations
    Department of Urology, Eastern Virginia Medical School, Norfolk, VA

    Devine-Jordan Center for Reconstructive Surgery and Pelvic Health, Urology of Virginia, Virginia Beach, VA
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  • Jack M. Zuckerman
    Affiliations
    Department of Urology, Eastern Virginia Medical School, Norfolk, VA

    Devine-Jordan Center for Reconstructive Surgery and Pelvic Health, Urology of Virginia, Virginia Beach, VA

    Department of Urology, Naval Medical Center, Portsmouth, VA
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  • Robert Strehlow VI
    Affiliations
    Department of Urology, Eastern Virginia Medical School, Norfolk, VA

    Devine-Jordan Center for Reconstructive Surgery and Pelvic Health, Urology of Virginia, Virginia Beach, VA

    Spartanburg Medical Center, Spartanburg, SC
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  • Ramón Virasoro
    Affiliations
    Department of Urology, Eastern Virginia Medical School, Norfolk, VA

    Devine-Jordan Center for Reconstructive Surgery and Pelvic Health, Urology of Virginia, Virginia Beach, VA
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  • Jessica M. DeLong
    Affiliations
    Department of Urology, Eastern Virginia Medical School, Norfolk, VA

    Devine-Jordan Center for Reconstructive Surgery and Pelvic Health, Urology of Virginia, Virginia Beach, VA
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  • Jeremy Tonkin
    Affiliations
    Department of Urology, Eastern Virginia Medical School, Norfolk, VA

    Devine-Jordan Center for Reconstructive Surgery and Pelvic Health, Urology of Virginia, Virginia Beach, VA
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  • Kurt A. McCammon
    Correspondence
    Address correspondence to: Kurt McCammon, M.D., F.A.C.S., F.P.M.-R.S., Devine-Jordan Center for Reconstructive Surgery and Pelvic Health, Urology of Virginia, 225 Clearfield Ave, Virginia Beach, VA 23462.
    Affiliations
    Department of Urology, Eastern Virginia Medical School, Norfolk, VA

    Devine-Jordan Center for Reconstructive Surgery and Pelvic Health, Urology of Virginia, Virginia Beach, VA
    Search for articles by this author

      Abstract

      Objective

      To assess efficacy and safety of liposomal bupivacaine (LB) infiltration of the buccal mucosal graft (BMG) harvest site in alleviating pain by evaluating the postoperative narcotic usage, pain score, and morbidities.

      Patients and Methods

      Single-blinded randomized controlled trial of 43 adult patients for BMG substitution urethroplasty between January 2015 to June 2017 (Clinicaltrials.gov: NCT03720223). A computer-generated allocation scheme randomized patients to control group (n = 22) no further local anesthetic infiltration aside from that of used in the hydrodissection for BMG harvest, and to intervention group with additional infiltration of LB to BMG harvest site (n = 21). We assessed postoperative cumulative narcotic use on post-op day 1 and 2 (24- and 48-hour total intravenous [IV] morphine equivalents in milligrams). A self-reported 10-point numeric rating scale survey was administered to assess postprocedural oral pain, oral conditions, and morbidity on days 1-3, and at 1-month follow-up. Fisher's exact test and independent T test were performed to assess differences between treatment groups. Linear regression was used to determine adjusted effect estimates of intervention.

      Results

      Compared to controls, a significantly lower narcotic use was noticed among the LB treatment group on post-op day 1 (IV morphine equivalent mean difference 8.58 mg; 95% confidence interval 1.59, 15.56, P =.017), while no significant difference was noticed on post-op day 2. There was no significant difference between treatment groups with regards to postprocedural oral pain score or oral morbidities.

      Conclusion

      Our study showed that LB infiltration of the BMG harvest site is safe and associated with lower 24-hour narcotic use only at post-op day 1.
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