The Safety of Perioperative Liposomal Bupivacaine Injections in Dermatologic Surgery Patients

BACKGROUND: There is a paucity of literature investigating the use of liposomal bupivacaine (LB) in a dermatologic surgery setting. OBJECTIVE: To identify the treatment characteristics and adverse events, including Local Anesthetic System Toxicity (LAST), in patients receiving perioperative LB. MATERIALS AND METHODS: A retrospective chart review was performed at a single institution using an institutional database and key words "Exparel" or "liposomal bupivacaine." Patients ≥18 years old who received perioperative LB to the surgical site and surrounding skin were included. RESULTS: A total of 140 LB administrations and 129 patients were included. Liposomal bupivacaine was used most often in the setting of excisions ( n = 88, 62.9%) and Mohs micrographic surgery ( n = 49, 35%), with hidradenitis suppurativa ( n = 77, 55%) and cutaneous neoplasms ( n = 56, 40%) the most frequent diagnoses. The median postoperative area and length were 23.6 cm 2 and 15.4 cm, respectively. The median LB dosage was 20 mL (range 1.5-20). There were no adverse events in 134 out of 136 patients of LB administration (98.5%). There were 2 reports (1.5%) of nausea on POD1 while these patients were taking opioids. CONCLUSION: Liposomal bupivacaine should be considered for postoperative analgesia in patients undergoing dermatologic surgery because it is well tolerated and efficacious. The authors observed no cases of LAST.