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Liposomal Bupivacaine at Cesarean Delivery, Minimizing Opioid use for Post-operative Pain Control [17J]

Cherot, Elizabeth, MD, MBA; Kett, Atilla, MD, MBA; Mauro, Rachel, MD

doi: 10.1097/01.AOG.0000533481.39090.65
Saturday, April 28, 2018: PDF Only

INTRODUCTION: Cesarean delivery is the most common in-patient surgery performed in the United States. Opioids are frequently prescribed post-operatively; this can lead to misuse or even illegal distribution.

METHODS: We infiltrated liposomal bupivacaine at the time of fascial closer of a Pfannenstiel incision, during a cesarean section. An 80cc solution was divided into four infiltrates of 5cc of Liposomal Bupivacaine, 6cc of .5% Bupivacaine and 9cc of Normal Saline each. Half of the solution was injected laterally under the fascia and the remaining was distributed evenly subcutaneously. Post-operative management was standardized with intrathecal morphine, scheduled Ketorolac and Ofirmev for the first 24 hours intravenously. Scheduled PO ibuprofen and acetaminophen were continued for forty-eight hours postoperatively. Oxycodone was ordered as needed but not scheduled. We used our SeamlessMD smartphone application to collect data on pain control and patient satisfaction. We reviewed in-patient charts and outpatient EMR records post-operatively for two weeks

RESULTS: Of the 11 cases, five patients used no narcotics, and one outlier was identified as a potential abuser. The mean morphine equivalent was 7.5mg or one 5mg oxycodone over the inpatient and 2 week post-operative period. The average length of stay was 2.2 days. The response rate was 42% to patient satisfaction questions.

CONCLUSION: Liposomal Bupivacaine reduces opioid use in the post- operative time period for cesarean section. It increased patient satisfaction and improved pain control, shortening length of stay. Further randomized control studies to determine the best delivery method are warranted.

Axia Womens Health, East Brunswick, NJ

Financial Disclosure: The authors did not report any potential conflicts of interest.

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.