(P 405) LIPOSOMAL BUPIVACAINE DOESN'T REDUCE NARCOTIC USE OR PAIN SCORES COMPARED TO A MULTIDRUG COCKTAIL FOLLOWING SOFT TISSUE TUMOR REMOVAL: PRELIM RESULTS OF A PROSPECTIVE, RANDOMIZED DOUBLE-BLINDED STUDY

Objective: In recent years, there has been a significant effort in various surgical specialties to develop post-surgical protocols incorporating multimodal analgesia, aimed at reducing both narcotic usage and costs. The well-documented adverse effects of narcotics, along with their potential for addiction, highlight the importance of exploring alternative pain management strategies. This study aims to present preliminary findings from a prospective, randomized double-blinded trial comparing patient-reported pain scores and narcotic consumption following soft tissue tumor removal. Specifically, the study evaluates outcomes between patients receiving liposomal bupivacaine (Exparel) versus a multidrug cocktail of ropivacaine, epinephrine, ketorolac, and clonidine.

Methods: This is a prospective, randomized double-blinded study set to enroll 140 patients undergoing soft tissue tumor removal. 70 patients would receive Exparel and the other 70 the cocktail drug. Inclusion criteria for the study was as follows: all primary soft tissue tumors in patients over the age of 18. In the postoperative period, patients were asked to fill out a postoperative pain score assessment sheet until they returned to the office. Any consumption of narcotics or drugs taken in between that time frame were also recorded. During the preliminary analysis, a T-Test was performed to compare the outcomes in 36 subjects from the Exparel cohort versus 34 in our multidrug cocktail group.

Results: Of the 36 subjects from the liposomal bupivacaine group analyzed, the average reported pain score value postoperatively was 1.89, versus 1.73 for the 34 multidrug cocktail subjects. No statistically significant difference in postoperative pain scores existed between the two groups (p= 0.63). In addition, there was no statistically significant difference in narcotic consumption rates between the two cohorts postoperatively (p= 0.53). The cost for Exparel per procedure was $2,489 versus $220 for the multidrug cocktail drug. If the cocktail drug had been used in lieu of the Exparel for all index procedures, the hospital would have saved $81,684. Twelve patients reported no use of narcotics in the multidrug cocktail cohort, with seven patients reporting no narcotic use in the Exparel group. There were no adverse drug reactions in either group.

Conclusion: The present study demonstrates there is no statistically significant difference in postoperative pain scores or narcotic consumption for patients treated with liposomal bupivacaine compared to the drug cocktail for patients with soft tissue tumors. We estimate that the use of the present cocktail compared to Exparel would save our hospital system approximately $2,200 per case. Given the rising necessity of hospital systems to allocate funds, future research studies should confirm our findings utilizing a larger sample size and randomized controlled trials to further evaluate the cost effectiveness of Exparel and the potential burden it imposes on hospital systems.