Are Patients Interested in Liposomal Bupivacaine as a Nonopioid Alternative for Postsurgical Analgesia Following Third Molar Extractions?

Abstract

Background: Liposomal bupivacaine (LB) is a long-acting local anesthetic used for postsurgical analgesia to reduce pain and the need for opioid pain medication.

Purpose: The purpose of this study was to assess patient interest in the use of LB as an alternative to opioid pain medication following third molar extraction.

Study design, setting, sample: A cross-sectional, questionnaire-based study was performed. Study subjects included patients 17 years old or greater who presented to the Oral and Maxillofacial Surgery clinic at Thomas Jefferson University for third molar extraction from May 2019 through January 2020.

Main outcome variables: The primary outcome variable was patient interest in LB, defined by "yes" or "no" from the survey question: "would you be interested in an alternative medication administered during the procedure that may decrease the need for opioid pain medication?". The secondary outcome variable was patient willingness to pay (WTP) for LB, defined by the out-of-pocket cost threshold patients reported they would pay.

Covariates: Covariates included patient demographics, attitudes towards opioid medication, and prior opioid use.

Analyses: Data were analyzed using descriptive statistics, Fisher's exact test, Kruskal-Wallis and Dunn's tests, Kendall's tau correlation, and multivariable logistic regression. Statistical significance was set at P value < .05.

Results: A total of 183 subjects completed the study (68% female, 32% male). The mean age was 27.5 years ± 11.1 years. Most subjects (76%) were interested in LB, but 88% had a WTP threshold below $200. Interest in LB was associated with higher WTP thresholds (adjusted odds ratio {aOR} 2.07; 95% confidence interval {CI} [1.48, 3.13]; P < .001). There was also an association between interest and subjects concerned of the addictive potential of opioids (aOR 4.04; 95% CI [1.52, 11.49]; P = .01) and between interest and previous use of prescribed opioid medication (aOR 6.00; 95% CI [1.59, 31.23]; P = .02).

Conclusions and relevance: Although most subjects were interested in LB, the current out-of-pocket cost of LB appears to be a barrier to patient acceptability. A lower cost option may increase the accessibility and adoption of this nonopioid analgesic for postoperative pain control in third molar extractions.