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Randomized Controlled Trial
. 2022 Nov 1;48(11):1135-1139.
doi: 10.1097/DSS.0000000000003567. Epub 2022 Aug 23.

Bupivacaine to Reduce Pain and Narcotic Use After Mohs Micrographic Surgery

Vanessa B Voss  1 , Clara Oh  1 , Surya Veerabagu  2 , Shannon Nugent  2 , Cerrene Giordano  2 , Nicholas J Golda  1
Affiliations
Randomized Controlled Trial

Bupivacaine to Reduce Pain and Narcotic Use After Mohs Micrographic Surgery

Vanessa B Voss et al. Dermatol Surg. .

Abstract

Background: Limited data exists for bupivacaine injection after Mohs micrographic surgery (MMS).

Objective: Evaluate how bupivacaine affects postoperative pain and narcotic use.

Materials and methods: In this multicenter, single-blinded, prospective randomized controlled trial, patients received bupivacaine or saline (placebo) immediately after MMS with flap reconstructions identified by American Academy of Dermatology expert consensus as high-risk for pain and narcotic use. For 48 hours postoperatively, patients logged analgesic use, pain scores (0-10), and whether pain was controlled.

Results: One hundred seventy-four patients were included. Narcotic analgesic use was higher in the placebo group during the first 24 hours (odds ratio 2.18; confidence interval [CI]: 1.08-4.41; p = .03), second 24 hours (odds ratio 2.18; CI: 0.91-5.29; p = .08), and 48 hours combined (odds ratio 2.58; CI: 1.28-5.24; p < .01). Pain scores were lower in the bupivacaine group during the first 8 hours (mean difference 1.6; CI: 0.73-2.38; p < .001). Overall analgesic use (narcotic and non-narcotic) and percentage of patients reporting pain under control were similar between groups. There were no significant differences in demographics or surgical characteristics. No adverse events occurred.

Conclusion: Single-dose bupivacaine decreased postoperative pain and narcotic analgesic use after MMS with reconstructions likely to cause significant pain. Bupivacaine may have a role in postoperative pain management and reducing narcotic use in this population.

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References

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