Small Animal Surgery Resident VCA Animal Specialty Group- Los Angeles
Nocita(bupivacaine liposome injectable solution) is used off-label as a local anesthetic for soft tissue surgery. Prospective data evaluating incisional complications(IC) with Nocita is lacking. Our objective was to document IC in Nocita-infused laparotomy incisions and identify associated risk factors. We hypothesized that there would be negative associations with SSI risk factors, but not Nocita-related variables. SSI risk factor and Nocita-related data were prospectively collected in dogs undergoing laparotomy. IC were defined according to CTCAE and CDC guidelines. Incisions were evaluated postoperatively and after 2 weeks. Univariate statistics(Wilcoxon-rank sum and Chi-squared tests) and multiple logistic regression were performed. Three hundred twenty-one dogs completed the study(2019-2020). IC were reported in 276/321 dogs(86%) during hospitalization and in 80/321 dogs(25%) two weeks postoperatively. Immediately postoperatively, odds of IC decreased by 67% per increase in volume(ml) per cm incision infused and by 8.4% for every minute of contact time. Two weeks postoperatively, odds of IC were increased with body weight (2.3% per kg), and male gender(89%), and decreased with neutering(54.3%). Odds of IC also increased by 6 times with staples and 8.6 times with self-trauma. Odds of IC were increased with multiple SSI risk factors but volume-per-incision ratio(ml/cm), the only significant Nocita-related variable, decreased the odds of IC. Despite the high initial incidence of IC, the majority of Nocita-infused incisions healed after 2 weeks. Study limitations include its observational nature, off-label use of Nocita, and subjectivity of IC. As most IC resolved uneventfully, the benefits of Nocita during laparotomy may outweigh the potential risks for IC.
