Liposomal bupivacaine after reduction mammaplasty: is it worth the shot? A single-blind, breast-split randomized clinical trial

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Background Reduction mammaplasty is a common procedure to relieve symptoms of macromastia. Amid the ongoing opioid crisis, improving postoperative pain control with judicious opioid prescribing practices has become a clinical priority. Liposomal bupivacaine (LB; Exparel) is a long-acting local anesthetic that may reduce opioid requirements, though evidence supporting its use in breast reduction is limited. This study evaluated the efficacy of LB in reducing postoperative pain following reduction mammaplasty. Methods In this prospective, single-blind, breast-split controlled trial, 32 adult female patients undergoing bilateral reduction mammaplasty were enrolled at a single academic center after IRB approval. Each breast received standard bupivacaine (SB; 0.25% bupivacaine hydrochloride); one side was randomly assigned to receive additional LB. Pain scores were recorded using the Numerical Pain Rating Scale (0-10) twice daily on postoperative days (POD) 1 through 3. Pain scores between sides were analyzed using paired t-tests and Wilcoxon signed-rank tests. Results The average patient age was 45.4 years (SD 14.4), with a mean BMI of 29.5 kg/m² (SD 4.3). No patients were lost to follow-up. Pain scores were lower on the LB side during POD1 and POD2. The greatest difference was noted on POD1 AM, with a mean reduction of -0.8 and median difference of -1 (p=0.012). By POD3, pain scores equalized between sides. No adverse events or complications were observed. Conclusion LB provided a modest reduction in pain scores during the first two postoperative days compared to standard bupivacaine. A more robust, adequately powered study is necessary to confirm the findings.