APS Aesthetic Plastic Surgery · 2024

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

Alameddine KO, Richards BA, Vyas K, Chaudhry A, Millesi E, Hamilton GS, Bite U.

PubMed 37775576 Publisher (DOI)Free full text (PMC)

What this paper says

Rhinoplasty patients who received liposomal bupivacaine reported an average pain score of 2.4 compared with 3.4 for those who did not, and used less opioid medication.

Overview

Opioids are commonly used for pain after rhinoplasty, raising concerns about side effects and overprescription. Liposomal bupivacaine is a long acting local anesthetic that releases slowly, and its role in rhinoplasty had not been well studied. The authors retrospectively compared patients who received it against those who did not, in operations performed between January 2014 and September 2020.

Sections of note

Design: retrospective comparative study. Level of evidence III.
Pain scores were assessed at intervals up to 16 hours after surgery, and opioid use was tracked.
Group 1 received postoperative liposomal bupivacaine; group 2 did not. Demographics and surgical details did not differ significantly between groups.
Pain at 30 minutes: 1.4 in group 1 versus 3.7 in group 2, p equal to 0.0006.
Pain at 2 hours: 2.2 versus 3.38, p equal to 0.0417.
Cumulative average pain: 2.4 versus 3.4, p equal to 0.0023.
Opioid use was lower in group 1 for both oxycodone, p equal to 0.005, and oral morphine equivalents, p equal to 0.0428.
The authors state the findings need validation in larger prospective studies.

What it means for a patient

A long acting local anesthetic given at the time of surgery reduced pain in the first hours and cut how much opioid was needed.
Pain scores in both groups were low in absolute terms, around 2 to 3 on the usual 10 point scale, so this shifts an already moderate level of pain.
The measurement window ended at 16 hours, so the effect on the days following surgery is not shown.
Limits: retrospective, not randomized, no stated patient numbers in the abstract, and single center.

Why this paper matters

Reducing opioid prescribing after elective surgery has become a routine goal, and rhinoplasty is a high volume procedure with moderate pain. A long acting local anesthetic addresses the window when opioids are most used. Whether the benefit extends past the first day, and whether it justifies the cost, is unanswered.

Terms

Liposomal bupivacaine: a local anesthetic packaged in fat bubbles so it releases over an extended period.
Local anesthetic: a drug that numbs a specific area of the body.
Oral morphine equivalent: a standard unit converting different opioids to a comparable dose.
Oxycodone: a commonly prescribed opioid pain medication.
Retrospective study: research that reviews records of care already delivered.

Summary written by rhinoplasty.cc from the abstract, 2026-09-09; not medical advice. The authors' own abstract follows.

Abstract

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: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Abstract as indexed by PubMed; the article is open access (PubMed Central).