Reducing Postoperative Opioid Use: Adjunctive Pain Control in Tonsillectomy

Introduction: Tonsillectomy is one of the most common surgical procedures performed by otolaryngologists. Optimizing pain control postoperatively continues to pose a challenge. Our group sought to evaluate the effects of using Exparel bupivacaine liposome suspension 1.3% (13.3 mg/mL) as an adjunct to standard of care medication in adult tonsillectomy patients.

Methods: In a randomized controlled trial, the study arm (n=22) received Exparel bupivacaine liposome suspension 1.3% as an adjunct to the standard of care (SOC) medication bupivacaine HCl 0.25% with epinephrine. The control group (n=20) received SOC bupivacaine HCl 0.25% with epinephrine. All injections were administered after excision of the tonsil and prior to conclusion of the operative procedure. Pre- and post-operative clinicopathologic variables of interest were collated from electronic medical records and review of patients' daily pain diaries. Results were analyzed via standard univariate statistics, linear mixed models, and Poisson regression.

Results: The Exparel + SOC group experienced significantly less pain at postoperative day (POD) 3 compared to the control group (p < 0.05). Mean pain score decreased on average by 1.23 points in the Exparel + SOC group and increased on average by 0.39 points in the control group (adj. p-value < 0.001). Similarly, analysis showed that maximum pain score decreased on average by 0.64 points in the Exparel + SOC and increased on average by 0.61 points in the control group (adj. p-value < 0.001). There was a statistically significant decrease in amount of oxycodone used between POD3 and POD5 within the Exparel + SOC group (16.39 mg vs 7.22 mg, p-value=0.035). The relative proportion of patients who used oxycodone was less in the Exparel + SOC group compared to the control group across all PODs.

Conclusions: Use of Exparel bupivacaine liposome suspension in adult tonsillectomy can decrease postoperative opioid use compared to standard of care treatment. These findings may serve as guidance for best practices in adult tonsillectomy. Future study will focus on optimal dosing and timing of drug administration.