Is Postoperative Pain After Abdominal Wall Reconstruction Better Managed with Liposomal Bupivacaine?

U.S.A.: According to a research study published in Annals of Surgery, there were no obvious clinical advantages to employing liposomal bupivacaine transversus abdominis plane block for postoperative pain control following open abdominal wall reconstruction.

Postoperative discomfort can have a big effect on how comfortable the patient is with their life in general. The best acute pain management practices, according to the literature, may also have an impact on whether or not post-operative chronic pain develops. Although liposomal bupivacaine is frequently used to block the transversus abdominis plane, there is little research to support its usage in open abdominal wall restoration.

The authors of this study predicted that, compared to placebo, liposomal bupivacaine plane block would reduce the need for opioids in the first 72 hours following surgery.

To achieve this goal, a single-center, double-blind, placebo-controlled prospective trial was carried out between July 2018 and November 2019. Patients who underwent open, elective, ventral hernia repairs with mesh positioned in the retromuscular position and who were adults (at least 18 years of age) were included in the study. Patients were randomly assigned to receive a liposomal, simple, or saline transversus abdominis plane block from the surgeon (placebo). The main result was the amount of opioids needed in the first 72 hours following surgery. The total amount of inpatient opioid use, pain scores calculated using a 100 mm visual analog scale, hospital stay duration, and patient-reported quality of life were considered secondary outcomes. 52 individuals received a placebo, 55 patients received basic bupivacaine, and 57 patients received liposomal bupivacaine out of the 164 patients who were included in the analysis.

Key findings of the research:

• When liposomal bupivacaine was compared to simple bupivacaine and placebo, there were no changes in the total opioid used in the first 72 hours following surgery as determined by morphine milligram equivalents (325 225 vs. 350 284 vs. 310 272, respectively, P = 0.725).
• Overall inpatient opioid use, pain levels, duration of stay, and patient-reported quality of life did not differ from one another.

The authors concluded that when compared to basic bupivacaine and placebo for open abdominal wall reconstruction, utilizing liposomal bupivacaine transversus abdominis plane block did not appear to provide any clinical advantages.

REFERENCE

Fafaj, Aldo MD*; Krpata, David M. MD*; Petro, Clayton C. MD*; Prabhu, Ajita S. MD, FACS*; Rosenblatt, Steven MD*; Tastaldi, Luciano MD†; Alkhatib, Hemasat MD*; Tu, Chao MS‡; Zolin, Samuel J. MD*; Thomas, Jonah D. MS*; Costanzo, Adele M. RN*; Rosen, Michael J. MD, FACS*. The Efficacy of Liposomal Bupivacaine on Postoperative Pain Following Abdominal Wall Reconstruction: A Randomized, Double-blind, Placebo-controlled Trial. Annals of Surgery: August 2022 - Volume 276 - Issue 2 - p 224-232 doi: 10.1097/SLA.0000000000004424