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

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

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)170-177
Number of pages8
JournalDiseases of the colon and rectum
Volume60
Issue number2
DOIs
StatePublished - Feb 1 2017

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Abdominal Muscles
Colorectal Surgery
Bupivacaine
Postoperative Pain
Opioid Analgesics
Ketorolac
Pain
Analgesia
Ibuprofen
Robotics
Acetaminophen
Tertiary Care Centers
Laparotomy
Anesthetics
Inpatients
Length of Stay
Hospitalization
Cohort Studies
Retrospective Studies
Databases

All Science Journal Classification (ASJC) codes

  • Gastroenterology

Cite this

@article{600b675bc3664697a266129ca332b71d,
title = "Liposomal Bupivacaine Use in Transversus Abdominis Plane Blocks Reduces Pain and Postoperative Intravenous Opioid Requirement after Colorectal Surgery",
abstract = "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.",
author = "Stokes, {Audrey L.} and Adhikary, {Sanjib D.} and Ashley Quintili and Puleo, {Frances J.} and Choi, {Christine S.} and Hollenbeak, {Christopher S.} and Evangelos Messaris",
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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.; Adhikary, Sanjib D.; Quintili, Ashley; Puleo, Frances J.; Choi, Christine S.; Hollenbeak, Christopher S.; Messaris, Evangelos.

In: Diseases of the colon and rectum, Vol. 60, No. 2, 01.02.2017, p. 170-177.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Liposomal Bupivacaine Use in Transversus Abdominis Plane Blocks Reduces Pain and Postoperative Intravenous Opioid Requirement after Colorectal Surgery

AU - Stokes, Audrey L.

AU - Adhikary, Sanjib D.

AU - Quintili, Ashley

AU - Puleo, Frances J.

AU - Choi, Christine S.

AU - Hollenbeak, Christopher S.

AU - Messaris, Evangelos

PY - 2017/2/1

Y1 - 2017/2/1

N2 - 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.

AB - 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.

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