Abstract:
OBJECTIVE:To analyze differences in length of stay, opioid use, and other perioperative outcomes in patients undergoing radical cystectomy with urinary diversion who received either liposomal bupivacaine (LB) or epidural analgesia. METHODS:This was a single center, retrospective cohort study of patients undergoing open radical cystectomy with urinary diversion from 2015-2019 in the early recovery after surgery (ERAS) pathway. Patients received either LB or epidural catheter analgesia for post-operative pain control. LB was injected at the time of fascial closure to provide up to 72 hours of local analgesia. The primary outcome was post-operative length of stay. Secondary outcomes were post-operative opioid use, time to solid food, time to ambulation, and direct hospitalization costs. Multivariable Cox proportional hazards regression was used to determine associations between analgesia type and discharge. RESULTS:LB use was independently associated with shorter post-operative length of stay compared to epidural use (median (IQR) 4.9 days (3.9-5.8) vs 5.9 days (4.9-7.9), P<.001), less total opioid use (mean 188.3 vs 612.2 OME, P <.001), earlier diet advancement (mean 1.6 vs 2.4 days, P <.001), and decreased overall direct costs ($23,188 vs $29,628, P <.001). 45% of patients who received LB were opioid-free after surgery, none in the epidural group. On multivariable Cox proportional hazards regression modeling, LB use was independently associated with earlier discharge (HR 2.1, IQR 1.0-4.5). CONCLUSION:Use of LB in open radical cystectomy is associated with reduced LOS, less opioid exposure, and earlier diet advancement.
journal_name
Urologyjournal_title
Urologyauthors
Chu CE,Law L,Zuniga K,Lin TK,Tsourounis C,Rodriguez-Monguio R,Lazar A,Washington SL 3rd,Cooperberg MR,Greene KL,Carroll PR,Pruthi RS,Meng MV,Chen LL,Porten SPdoi
10.1016/j.urology.2020.11.036subject
Has Abstractpub_date
2020-12-03 00:00:00eissn
0090-4295issn
1527-9995pii
S0090-4295(20)31426-6pub_type
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