eP450 - Outcomes for Patients Undergoing Laparoscopic Colorectal Surgery Receiving Incisional Extended-release Bupivacaine and Meloxicam

Purpose/Background: Post-operative pain control is essential to both patients and surgeons. Many pain control methods are currently utilized such as epidural, local anesthetic, and oral/intravenous pain medications. The purpose of this analysis was to determine if there was a difference in outcomes between patients undergoing laparoscopic colon surgery who received incisional extended-release bupivacaine and meloxicam when compared to patients receiving standard of care with epidural analgesia. The primary outcome was morphine milligram equivalents (MME) used during hospitalization and the secondary outcome was hospital length of stay (LOS).Methods/Interventions: We performed a retrospective cohort study of elective hand-assisted laparoscopic colon resections in adults at one large academic medical center. Patients who received intraoperative, incisional extended-release bupivacaine and meloxicam were matched 1:2 with patients who did not based on age and type of operation. Patients taken back to the operating room within 7 days of surgery and those receiving a concurrent operation were excluded. Chart review was performed to extract data. Multivariable logistic regression which included fibromylagia and prior opiate prescription as covariates (both selected a priori) was performed on the matched cohort to estimate odds ratio (OR) of decreasing LOS by one day and the odds ratio of decreasing MME by one.Results/Outcomes: Our cohort included 57 patients – 19 (33%) that received the study medication and 38 (67%) that did not. All operations were hand-assisted laparoscopic and included sigmoidectomy (n=27, 47%), right hemicolectomy (n=24, 42%), and left hemicolectomy (n=6, 11%). The average LOS in the cohort was 2.3 days while the average MME was 47. When performing a T-test, patients receiving the study medication had no difference in MME – 37 vs.54 (p=0.30). When performing a T-test, those that received the study medication had decreased LOS – 1.7 vs 2.6 (p=0.02). Additionally, patients receiving the study drug had higher adjusted odds of decreasing MME by one when compared to patients not receiving the study medication (OR = 3.16 [95% CI 1.10 to 9.01], p=0.032). Patients receiving the study drug had higher adjusted odds of decreasing LOS by one when compared to patients not receiving the study medication (OR = 5.55 [95% CI 1.56 to 19.79], p=.008)Conclusion/

Discussion: Our study demonstrates that intraoperative extended-release bupivacaine and meloxicam may be a superior pain management regimen in patients undergoing hand-assisted laparoscopic colon surgery when compared to our institution's standard of epidural. This result is important given the logistical challenges of epidural placement preoperatively and the challenges that patients can face with epidural function on the floor post-operatively and can potentially be extracted to open surgery. Our findings are likely due to issues troubleshooting epidurals on the floor. Prospective studies should be conducted to validate our findings, to determine outcomes for the study medication in open and laparoscopic surgery, and to determine if there are other benefits to its use such as cost and patient satisfaction when compared to other pain management modalities.