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

Stokes, Audrey L.; Adhikary, Sanjib Das; Quintili, Ashley; Puleo, Frances J.; Choi, Christine S.; Hollenbeak, Christopher S.

doi:10.1097/dcr.0000000000000747

Cited by 60 publications

(46 citation statements)

References 26 publications

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“…21,22 Similar outcomes have also been documented in nonorthopedic cases, including hemorrhoidectomy, bunionectomy, and colorectal and retropubic slingplacement surgeries. 16,17,23,24 Despite these findings, the local anesthetic's effectiveness in reducing postoperative pain and opioid use in spine surgeries has not been well defined.…”

Section: Discussionmentioning

confidence: 99%

The Efficacy of Liposomal Bupivacaine in Lumbar Spine Surgery

Brown¹,

Weir²,

Shasti³

et al. 2018

Int J Spine Surg

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Background: Postoperative pain management in spine surgery holds unique challenges. The purpose of this study is to determine if the local anesthetic liposomal bupivacaine (LB) reduces the total opioid requirement in the first 3 days following posterior lumbar decompression and fusion (PLDF) surgery for degenerative spondylosis.Methods: Fifty patients underwent PLDF surgery in a prospective randomized control pilot trial between August 2015 and October 2016 and were equally allocated to either a treatment (LB) or a control (saline) group. Assessments included the 72-hour postoperative opioid requirement normalized to 1 morphine milligram equivalent (MME), visual analog scale (VAS), and hospital length of stay.Results: LB did not significantly alter the 72-hour postoperative opioid requirement compared to saline (11.6 vs. 13.4 MME, P ¼ .40). In a subgroup analysis, there was also no significant difference in opioid consumption among narcotic-naive patients with either LB or saline. Among narcotic tolerant patients, however, opioid consumption was higher with saline than LB (20.6 MME vs. 13.3 MME, P ¼ .048). Additionally, pre-and postoperative VAS scores and hospital length of stay were not significantly different with either LB or saline.Conclusions: In the setting of PLDF surgery, LB injections did not significantly reduce the consumption of opioids in the first 3 postoperative days, nor did the hospital length of stay or VAS pain scores, compared to saline. However, LB could be beneficial in reducing the consumption of opioids in narcotic-tolerant populations.Level of Evidence: 2.

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Section: Discussionmentioning

confidence: 99%

The Efficacy of Liposomal Bupivacaine in Lumbar Spine Surgery

Brown¹,

Weir²,

Shasti³

et al. 2018

Int J Spine Surg

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“…In addition to decreased inhalant dosing, the need for rescue analgesia, including opioids, is decreased with the use of local/regional analgesia. In humans (Bergese et al, 2012;Blanco, Ansari, & Girgis, 2015;Boerboom et al, 2018;Candiotti, 2012;Lombardi, 2014;Malik, Kaye, Belani, & Urman, 2017;Marques et al, 2014;Stokes et al, 2017) and dogs/ cats (Benito et al, 2016;Carpenter et al, 2004;Flecknell, Kirk, Liles, Hayes, & Dark, 1991;Myrna et al, 2010;Perez et al, 2013;Savvas et al, 2008;Wenger, Moens, Jäggin, & Schatzmann, 2005), local anaesthetics significantly decrease the opioid requirements for intraoperative anti-nociception and postoperative analgesia. Using local anaesthetics to decrease opioid use could be very beneficial in both human and veterinary patients, not only because of the desire to reduce potential opioid-mediated adverse effects, such as dysphoria, vomiting and nausea, but also because the availability of potent opioids may be limited due to legislation, production or country/region.…”

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confidence: 99%

Local and regional anaesthesia in dogs and cats: Overview of concepts and drugs (Part 1)

Grubb

Lobprise

2020

Veterinary Medicine & Sci

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Pain management in veterinary patients is a crucial component of appropriate patient care. Multimodal analgesia that includes both systemically and locally/regionally administered drugs is generally the most effective approach to providing pain relief. Local anaesthetic drugs used in local and regional blockade are unique in that they can completely block the transmission of pain (in conscious patients) or nociceptive (in anaesthetized patients) signals, thereby providing profound analgesia. In addition, local and regional administration of drugs, when compared with systemic bolus administration, generally results in a lower incidence of dose‐related adverse effects. Due to the potential to provide profound analgesia and the high safety margin (when used correctly) of this drug class, local anaesthetics are recommended as part of the analgesic protocol in the majority of patients undergoing surgical procedures or suffering traumatic injuries. This manuscript, Part 1 of a two‐part instalment, emphasizes the importance of using local and regional anaesthesia as a component of multimodal analgesia, provides a review of the basic pharmacokinetics/pharmacodynamics of local anaesthetic drugs in general, lists information on commonly used local anaesthetic drugs for local and regional blockade in dogs and cats, and briefly introduces the novel liposome‐encapsulated bupivacaine (NOCITA®). Part 2 is a review of local and regional anaesthetic techniques used in dogs and cats (Grubb & Lobprise, 2020).

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“…We chose to use liposomal bupivacaine, which has a half‐life that is approximately five times longer than conventional bupivacaine . One study found a significant decrease in opioid use and superior pain control persisting up to 36 h after CRS in TAP block protocols using liposomal bupivacaine compared with nonliposomal agents . Interestingly, they observed this reduction in opioid use more in patients undergoing laparoscopic or robotic surgeries than open procedures, possibly due to the larger proportion of visceral pain in open cases that is not covered by TAP block .…”

Section: Discussionmentioning

confidence: 99%

Comparison of preoperative versus postoperative transversus abdominis plane and rectus sheath block in patients undergoing minimally invasive colorectal surgery

et al. 2019

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Aim Ultrasound-guided transversus abdominis plane and rectus sheath block (TAPRSB) decreases pain scores and narcotic use postoperatively after colorectal surgery (CRS). It is unclear if the effectiveness of TAPRSB varies according to whether it is performed preoperatively or postoperatively. Our aim was to investigate this.Method We compared patients who underwent preoperative TAPRSB or postoperative TAPRSB during minimally invasive CRS. Primary end-points were pain scores and oral morphine milligram equivalent (MME) use postoperatively. Secondary end-points included perioperative factors affecting pain scores and postoperative MME. Summary statistics and univariate analysis by nonparametric tests were utilized. The mixed-effect model was applied to model the repeatedly measured pain score.Results From April 2015 until May 2018 168 patients received TAPRSB before (115) or after (53) minimally invasive CRS. The cohort included 79 (47.0%) women, and had an average age of 59.11 (AE12.32) years and mean body mass index of 28.32 (AE5.82) kg/m 2 . Indication for surgery was cancer in 66 (39.3%), polyp in 43 (25.6%) and diverticulitis in 43 (25.6%). Right colec-tomy was performed in 61 (36.3%), low anterior resection in 46 (27.4%) and sigmoid colectomy in 40 (23.8%) patients. The demographics of the groups were similar. Postoperative TAPRSB was only associated with lower pain scores at 12 h postoperatively. As secondary outcomes, average pain scores and MME were lower in patients who were older, had right colectomy or intracorporeal anastomosis.Conclusions Postoperative TAPRSB resulted in lower pain scores than preoperative TAPRSB 12 h after minimally invasive CRS, but otherwise no differences were seen in pain scores or MME use.Keywords Transversus abdominis block, rectus sheath block, milligram morphine equivalent, pain score, minimally invasive colorectal surgeryWhat does this study add to the literature? This study provides data regarding the timing of transversus abdominis plane and rectus sheath block and its effect on postoperative pain scores and narcotic use in patients undergoing minimally invasive colorectal surgery. It also offers more data regarding a specific type of block, which includes four injection sites.Comparison of preoperative vs postoperative transversus abdominis plane J. Xia et al.

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

Cited by 60 publications

References 26 publications

The Efficacy of Liposomal Bupivacaine in Lumbar Spine Surgery

The Efficacy of Liposomal Bupivacaine in Lumbar Spine Surgery

Local and regional anaesthesia in dogs and cats: Overview of concepts and drugs (Part 1)

Comparison of preoperative versus postoperative transversus abdominis plane and rectus sheath block in patients undergoing minimally invasive colorectal surgery

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