Abstract 19005: Efficacy of Bupivacaine/Lidocaine Combination in Reducing Opioid Usage Following Pacemaker/Defibrillator Implantation: A Double-Blind Randomized Controlled Trial

Introduction: Bupivacaine (Bupi) and Lidocaine (Lido) are local anesthetics used in pacemaker/defibrillator implantation. Choice is primarily driven by time to take effect (and duration): Hypothesis: Opioid use (morphine equivalent in grams) within 24 hours of awakening from general anesthesia after pacemaker/defibrillator implantation will be lower in patients randomized to Lido (6 cc 1%)/Bupi (4 cc 0.25% solution) than Lido (10 cc 1% solution) alone. Methods: We randomized (1:1) 350 consented patients ≥18 years undergoing first isolated pacemaker/defibrillator (ICD, pacemaker) implantation for arrhythmia correction at one hospital (11/03/2008-08/30/2012), stratified by surgeon, device type, and gender. Local anesthetic was administered once according to randomization at time of surgery. Surgeons were blinded to randomization. Data on all opioids given ≤24 hours post-awakening from anesthesia were collected. Results: In the Lido/Bupi group, 61.6% of patients received opioids, vs 59.5% in the Lido group (adjusted odds ratio=1.00; 95%CI: 0.65, 1.53; p=0.98). The mean total amount received was lower but not significant in the Bupi/Lido group (6.5 mg morphine equivalent) than the Lido group (7.6 mg; adjusted difference = -1.82; 95%CI: -4.33, 0.68; p= 0.15) (see Table). Conclusions: We observed a lower morphine equivalent average in patients receiving Lido/Bupi vs Lido alone, but the difference was not significant. We cannot rule out the possibility that clinician and patient expectations regarding pain management impacted opioid use, masking the intervention effect. A larger study is needed to confirm our results.