O2060: Does Bupivacaine Liposome Injectable Suspension Further Aid in Decreasing At-home Narcotic Utilization in Children and Adolescents Following Anterior Cruciate Ligament Reconstruction: A Preliminary Report

Background: Opioid misuse and addiction among children and adolescents is an increasingly concerning problem. Post-surgical opioid prescriptions for commonly performed surgeries such as anterior cruciate ligament reconstruction (ACLR) increase opioid exposure in young athletes. The purpose of this study was to determine if addition of bupivacaine liposome injectable suspension to the admixture administered as a single-shot adductor canal peripheral nerve block (SPNB+BL) would decrease utilization of at-home opioid analgesics after ACLR in adolescents compared to single-shot peripheral nerve block with bupivacaine (SPNB+B) alone.

Methods: Consecutive patients who underwent ACLR with or without meniscal surgery by a single surgeon were enrolled in this prospective case-series study. All patients received a preoperative single-shot adductor canal peripheral nerve block with either admixture of bupivacaine liposome injectable suspension combined with 0.25% bupivacaine (Group 2, SPNB+BL) or 0.25% bupivacaine alone (Group 1, SPNB+B). Postoperative pain management included cryotherapy, oral acetaminophen, and ibuprofen. A prescription for 10 doses of hydrocodone/acetaminophen (5/325 mg) was provided in a sealed envelope with instructions that the prescription should only be used in the case of uncontrolled pain. Patients were asked to report their pain using the visual analog scale (VAS); number of consumed narcotics, acetaminophen, and ibuprofen; and their satisfaction with pain treatment for the first three days after surgery. Reports of no opioid use were corroborated by the unopened envelope and unfilled prescription. Statistical analysis was performed.

Results: Fifty-eight patients were enrolled in the study, (SPNB+B=32 patients, SPNB+BL=26 patients). Average age was 15 ± 1.5 years. A total of 47 patients (81%) did not require home opioid analgesia after surgery. A significantly lower proportion of patients in the SPNB+BL required opioids as compared to the patients in the control group (7.7% vs. 28.1%, p=0.048). Average opioid use was 2 MME or 0.4 pills (range, 0-20 MME), with only 2 patients reporting consuming 4 pills. There were no group differences in VAS scores, pain treatment satisfaction scores, other demographics, or other operative data. The groups did statistically differ in distribution of insurance type (p < 0.01), sex (p=0.039), and administering anesthesiologists’ years in practice (p=0.014); therefore, an inverse probability of treatment weighting (IPTW) analysis was performed to account for treatment group differences. Resulting analysis of home opioid use between groups remained significantly different (p < 0.001).

Conclusion: The findings of this study demonstrate that addition of bupivacaine liposome injectable suspension to the admixture administered as an adductor canal nerve block in children and adolescents undergoing ACLR effectively reduces home opioid usage postoperatively compared to bupivacaine alone.