184. Efficacy of Exparel in Pediatric Breast Reduction Surgery

PURPOSE: Among adults undergoing plastic surgery, liposomal bupivacaine (Exparel) use has been associated with improved postoperative pain scores, higher patient satisfaction and less narcotic requirements (Vyas et al., 2016). The use of Exparel in adults was understandably rapidly adopted given its potential for long term pain control. In 2021, the FDA approved Exparel for use in pediatric patients. Unfortunately, there is scant literature regarding the efficacy in the pediatric population. In this study, we sought to determine the effect of Exparel on post-operative pain levels, narcotic requirements, and nausea control compared to other local and regional anesthetic methods in pediatric patients undergoing elective breast surgery. METHODS: A retrospective review of all pediatric patients that underwent a bilateral breast reduction from 2012-2024 at a single institution by a single surgeon were identified. Patients were excluded if they underwent unilateral reduction, received no local or regional block, or were >18 years old at time of surgery. Patient demographics, oral morphine equivalents required during inpatient hospital stay, postoperative pain scores and nausea/vomiting episodes were recorded. Patients were categorized by the local or regional anesthetic blocks they received (paravertebral (PVB), pectoral (PB), lidocaine, or Exparel). Pain medication received was calculated in oral morphine equivalents (MEQ) for comparison. RESULTS: 88 patients met inclusion criteria. 18.2% (N=16) received lidocaine, 6.8% (N=6) underwent PB, 28.4% (N=25) underwent PVB and 46.6% (N=41) received Exparel. There were no significant differences between groups in terms of BMI, age, length of procedure, or total specimen weight. One way ANOVA demonstrated significant differences in MEQ between groups (p<0.001). Post hoc analysis showed that Exparel was also significantly associated with fewer oral morphine equivalents when compared to local with lidocaine (p<0.001). On multivariate analysis, Exparel and PB were independently associated with decreasing morphine equivalents (p < 0.001, p = 0.029). There was no difference in post-operative episodes of emesis between groups, total anesthesia time, or postoperative pain scores. CONCLUSIONS: Among pediatric patients undergoing elective breast surgery, the use of Exparel was associated with significantly less opioid use. Our data suggest that among pediatric patients, Exparel is effective for pain control and can help minimize narcotic use in this vulnerable population. This can be a safe and effective method of non-narcotic pain management particularly if regional blocks are not readily available.