An interesting article titled “Are Patients Interested in Liposomal Bupivacaine as a Nonopioid Alternative for Postsurgical Analgesia Following Third Molar Extractions?” written by Annie Ho and et. al. appears in the Journal of Oral and Maxillofacial Surgery (online August 9, 2023). The article seeks to determine a patient interest in the use of Liposomal Bupivacaine as an alternative to opioids after wisdom teeth extraction.
Studies have shown that patients given opioids after surgery have a 44% increased risk of long-term opioid use. Long lasting local anesthetics like liposomal bupivacaine (LB) were first approved in the U.S by the Food and Drug Administration in
2011. Only a single dose to the surgical site is needed for postsurgical analgesia. Research has shown that Liposomal Bupivacaine can lower cumulative pain scores, reduce opioid requirements, and make for faster discharges from the hospital.
Although Liposomal Bupivacaine controls pain well, it is expensive and currenty is sold in vials for $215 per 10 mL dose and $365 per 20 mL dose. Unfortunately dental or medical insurance plans do not often cover Liposomal Bupivacaine for wisdom teeth surgery. When covered, the reimbursements are low.
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To evaluate patient interest in Liposomal Bupivacaine and to measure the out-of-pocket price range patients are willing to pay the authors conducted a study with 183 patients age 17 and older. The patients were seen at the Oral and Maxillofacial Surgery clinic at Thomas Jefferson University Hospital for an appointment regarding wisdom teeth between May 2019 and January 2020. The respondents answered a questionnaire. Most respondents (76%) were interested in Liposomal Bupivacaine, but 88% had a patient willingness to pay threshold below $200. There was also an association between interest and subjects concerned of the addictive potential of opioids and between interest and previous use of prescribed opioid medication. There was also an association between between interest in the nonopioid alternative and patients’ concerns about the addictive potential of opioids. The authors state:
“The results of this study showed that the majority of subjects were interested in LB [Liposomal Bupivacaine] as an adjunctive medication for postoperative analgesia after third molar [wisdom teeth] extractions but were not willing to pay for the medication at its current price”
The authors feel that future studies comparing Liposomal Bupivacaine to standard opioid and nonopioid analgesics are needed to better understand the effectiveness of the treatment. The authors feel that a lower cost option may increase the accessibility and adoption of Liposomal Bupivacaine as a nonopioid alternative to manage postoperative pain after wisdom tooth surgery.