Abstract

Patient-controlled anesthesia (PCA) is utilized to treat acute, chronic, labor, and postoperative pain in patients. The administration of PCA intravenously (IV), through an epidural or peripheral nerve catheter, or transdermally each allow the patient to have autonomy over their pain control. Although beneficial in regard to patient care and outcomes, the current regimen of PCA is not cost-effective. Unused medication, cost of Anesthesia team consults, equipment, and the price of frequently used PCA medications contribute a substantial cost to hospital systems. Moreover, patient outcomes with PCA have been shown to be equivalent to those with traditional pain medication dosing. As such, we investigated two anesthetic routines in post operative cardiothoracic patients. In the novel group, we started to utilize Exparel™ (liposomal bupivacaine), which was instilled into the intercostal space at the conclusion of the surgical procedure. This Exparel™ receiving cohort did not receive PCA, and were instead managed as needed with narcotics in the post-operative period. Our prospective study with 10 patients, each undergoing a lobectomy, or surgical removal of a lobe of the lung, compared the outcomes in pain control and cost between Exparel™ and narcotic management and PCA. Our outcomes showed that the pain control was the same when controlling for the receiving arm. However, the cost of the PCA-receiving arm was substantially more. Given the pain control of the Exparel™ receiving arm is non-inferior, it should be considered an acceptable post-operative pain control option to PCA, given its decreased cost.