Liposomal Bupivacaine in Rhinoplasty: An Underused Tool

Evaluating the Efficacy of Liposomal Bupivacaine in Postoperative Pain Management for Rhinoplasty: A Retrospective Study

BACKGROUND

Rhinoplasty, a leading cosmetic surgical procedure, often involves the use of opioids for postoperative pain management. This raises concerns due to potential opioid side effects and overprescription. Liposomal bupivacaine offers a promising alternative, but its efficacy in rhinoplasty remains under-investigated. This study assesses the impact of liposomal bupivacaine on postoperative pain and opioid consumption following rhinoplasty.

METHODS

A retrospective study was conducted on patients undergoing rhinoplasty between January 2014 and September 2020. Postoperative pain scores were assessed at intervals up to 16 h, and opioid consumption was monitored. Patients were stratified into two groups: those receiving postoperative liposomal bupivacaine (Group 1) and those who did not (Group 2).

RESULTS

No significant disparities in demographics or surgical specifics were identified between groups. Group 1 consistently reported lower pain scores, notably at 30 min (1.4 vs. 3.7, p = 0.0006) and 2 h (2.2 vs. 3.38, p = 0.0417). Cumulatively, Group 1's average pain score was 2.4, significantly lower than Group 2's 3.4 (p = 0.0023). Group 1 also demonstrated reduced opioid consumption, with oxycodone and oral morphine equivalent (OME) intake being notably lower (p = 0.005 and p = 0.0428, respectively).

CONCLUSION

Liposomal bupivacaine presents as an efficacious alternative for post-rhinoplasty pain management, reducing both perceived pain and opioid consumption. While promising, the findings necessitate validation through larger, prospective studies considering the inherent limitations of this preliminary investigation. This study evaluates the efficacy of liposomal bupivacaine as a pain management strategy in postoperative care for rhinoplasty and septorhinoplasty procedures, with the potential to reduce reliance on opioids. The findings indicate that patients receiving liposomal bupivacaine experienced significantly lower pain scores postoperatively and less overall opioid consumption, thereby enhancing patient comfort and safety.

LEVEL OF EVIDENCE III

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Local and Regional Blocks for Complex Facial Wound Repair

The location, severity, and associated injuries of the head and neck trauma dictate the type and treatment location needed for that particular patient. An in-depth knowledge of local and regional block options is vital to the proper management of facial wounds at the bedside, decreasing need for general anesthesia, anesthesia-related complication, length of hospital stay, and overall hospital costs. This article will discuss local and regional block options for the upper-face, midface, and lower face including dentition; complications of local and regional blocks and how to prevent them; and recent advances in local anesthesia. In addition, conscious sedation as an adjunct to local/regional blocks in children or patients with special needs will be discussed.