Hannah Soltani, Rachel N Rohrich, Christopher M Ply, Sabrina F DeLeonibus, Kishan S Shah, Luke J Llaurado, Richard C Youn, Karen K Evans, Christopher E Attinger
Exparel and Marcaine provided superior donor site analgesia compared to lidocaine in patients undergoing STSG for chronic LE wounds. Pre-existing peripheral neuropathy was an independent predictor of higher pain, indicating that patient-specific factors should inform analgesic strategy. These findings support a personalized approach to donor site pain management, particularly in high-risk subgroups.
BACKGROUND: Donor site pain remains a clinically significant source of morbidity after split-thickness skin grafting (STSG), particularly in patients with chronic, atraumatic lower extremity (LE) wounds. Although liposomal bupivacaine (Exparel) and plain bupivacaine (Marcaine) are commonly used for donor site analgesia, their comparative effectiveness, particularly in the setting of pre-existing peripheral neuropathy, remains poorly understood in this population.
METHODS: We conducted a retrospective review of 228 patients who underwent STSG for chronic LE wounds from 2014 to 2022. Patients underwent donor site infiltration with Exparel (n=66), Marcaine (n=56), or lidocaine (n=106). Pain scores were assessed immediately postoperatively and at the first follow-up. Multivariate linear regression was performed to identify independent predictors of postoperative pain.
RESULTS: Immediate postoperative pain scores were significantly lower in patients receiving Exparel (0 [IQR 3]) and Marcaine (0 [2.5]) compared to lidocaine (2 [5], p=0.027). At follow-up, pain scores trended higher in the lidocaine group but did not reach significance (p=0.131). Patients with peripheral neuropathy reported significantly higher immediate postoperative pain than those without neuropathy (2 [5] vs. 0 [3], p=0.027). Multivariate analysis demonstrated that peripheral neuropathy (β=+1.09, p=0.007), female sex (β=+0.77, p=0.035), and lidocaine use (β=+0.89, p=0.029) were independently associated with higher pain scores.
CONCLUSIONS: Exparel and Marcaine provided superior donor site analgesia compared to lidocaine in patients undergoing STSG for chronic LE wounds. Pre-existing peripheral neuropathy was an independent predictor of higher pain, indicating that patient-specific factors should inform analgesic strategy. These findings support a personalized approach to donor site pain management, particularly in high-risk subgroups.