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Liposomal Bupivacaine Use in Transversus Abdominis Plane Blocks Reduces Pain and Postoperative Intravenous Opioid Requirement After Colorectal Surgery

Stokes, Audrey L. M.D.; Adhikary, Sanjib D. M.D.; Quintili, Ashley Pharm.D.; Puleo, Frances J. M.D.; Choi, Christine S. M.D.; Hollenbeak, Christopher S. Ph.D.; Messaris, Evangelos M.D., Ph.D.

doi: 10.1097/DCR.0000000000000747
Original Contributions: Benign

BACKGROUND: Enhanced recovery protocols frequently use multimodal postoperative analgesia to improve postoperative outcomes in patients undergoing colorectal surgery.

OBJECTIVE: The purpose of this study was to evaluate liposomal bupivacaine use in transversus abdominis plane blocks on postoperative pain scores and opioid use after colorectal surgery.

DESIGN: This was a retrospective cohort study comparing outcomes between patients receiving nonliposomal anesthetic (n = 104) and liposomal bupivacaine (n = 303) blocks.

SETTINGS: The study was conducted at a single tertiary care center.

PATIENTS: Patients included those identified within an institutional database as inpatients undergoing colorectal procedures between 2013 and 2015 who underwent transversus abdominis plane block for perioperative analgesia.

MAIN OUTCOME MEASURES: The study measured postoperative pain scores and opioid requirements.

RESULTS: Patients receiving liposomal bupivacaine had significantly lower pain scores for the first 24 to 36 postoperative hours. Pain scores were similar after 36 hours. The use of intravenous opioids among the liposomal bupivacaine group decreased by more than one third during the hospitalization (99.1 vs 64.5 mg; p = 0.040). The use of ketorolac was also decreased (49.0 vs 18.3 mg; p < 0.001). In subgroup analysis, the decrease in opioid use was observed between laparoscopic and robotic procedures but not with laparotomies. No significant differences were noted in the use of oral opioids, acetaminophen, or ibuprofen. Postoperative length of stay and total cost were decreased in the liposomal bupivacaine group but did not achieve statistical significance.

LIMITATIONS: The study was limited by its retrospective, single-center design and heterogeneity of block administration.

CONCLUSIONS: Attenuated pain scores observed with liposomal bupivacaine use were associated with significantly lower intravenous opioid and ketorolac use, suggesting that liposomal bupivacaine-containing transversus abdominis plane blocks are well aligned with the opioid-reducing goals of many enhanced recovery protocols.

1 Department of Surgery, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania

2 Department of Anesthesiology and Perioperative Medicine, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania

3 Department of Pharmacy, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania

4 Department of Public Health Sciences, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania

Financial Disclosure: Sanjib Adhikary was site primary investigator for multicenter trial evaluating liposomal bupivacaine in regional blocks for orthopedic surgery patients. No other financial disclosures have been reported.

Podium presentation at the meeting of The American Society of Colon and Rectal Surgeons, Los Angeles, CA, April 30 to May 4, 2016.

Correspondence: Evangelos Messaris, M.D., Ph.D., 500 University Dr, PO Box 850, H137, Hershey, PA 17033. E-mail:

© 2017 The American Society of Colon and Rectal Surgeons