267 A Prospective Analysis Describing the Innovative Use of Liposomal Bupivacaine to Manage Donor Site Pain in Burn Surgery Patients

Burn patients often require autograft harvesting from donor sites to facilitate wound healing, resulting in significant pain. Liposomal bupivacaine is indicated for administration into a surgical site to produce postsurgical analgesia. The objective of this study was to evaluate the efficacy and safety of liposomal bupivacaine vs. traditional management of donor site pain in burn patients. This observational, case-control study included adults with ≤ 20% TBSA who received liposomal bupivacaine for donor site pain after autograft. Prior to data collection, an institution-specific protocol was implemented. Cases were matched to historical controls treated with traditional pain management. Patients were matched on TBSA, donor site, and age. Primary outcome was cumulative pain scores on postoperative days 1, 2, and 3 measured by area under the pain score time curve (AUC). Secondary outcomes included total morphine equivalents (MME), length of stay, and study medication/opioid-related adverse events. 21 patients met inclusion criteria with 11 appropriate for matching. Average (SD) age 44 (15) years, 62% male, and median (IQR) TBSA 2 (2–4). Groups were well-matched at baseline. Median (IQR) AUC0-24 in cases was 578 (422–700) and 640 (237–752) in controls (p = 0.79). Median (IQR) MME were 60 (36–95) in cases and 87 (49.5–97.5) in controls in the first 24 hours (p = 0.212). There were no major adverse events related to liposomal bupivacaine (dosing is summarized in Table 1). AUC on postoperative day 1 was lower in liposomal bupivacaine patients. MME required in the first 24 hours were lower in the case group, likely not statistically significant due to small sample size. A post-hoc analysis demonstrated inadequate power as recruitment is ongoing. 10 patients who received liposomal bupivacaine were not admitted beyond 24 hours to fully assess the postoperative period, indicating patients recovered for discharge earlier than expected based on initial study design. To our knowledge, no previously published studies exist evaluating use of this agent in burn patients. Use of liposomal bupivacaine positively impacts patients by providing a multimodal approach to extended pain relief. Our study demonstrates the safe use and applicability of liposomal bupivacaine in burn surgery after autograft harvesting. Our protocol can be shared with other burn centers with potential for a multi-site study.