Liposomal Bupivacaine Versus Bupivacaine Hydrochloride with Lidocaine during Midurethral Sling Placement: A Randomized Controlled Trial

Prescription Opioid Use for Acute Pain and Persistent Opioid Use After Gynecologic Surgery

“…For the analyses, a total of 23 studies included data on opioids consumed after hospital discharge. 1,24–45 (Table 1 and Appendix 2; Appendix 2 is available online at http://links.lww.com/AOG/D47) Of these studies, eight included data on patients who had hysterectomy, 1,24–30 six included data on patients who had laparoscopic gynecologic surgery without hysterectomy, 30–35 10 included data on patients who had POP or incontinence surgery (with or without hysterectomy), 36–45 and two included data on other gynecologic surgeries not included in the prior mentioned categories. 30,33 Twelve article included data on persistent opioid use after gynecologic surgery 47–58 ; eight studies included data on patients who had hysterectomy, 47–54 three studies included data on patients who had laparoscopic gynecologic surgery without hysterectomy, 53,54,57 two studies included data on patients who had POP or incontinence surgery (with or without hysterectomy), 55,56 and four studies included data on other gynecologic surgeries not included in the prior mentioned categories.…”

AUGS-IUGA Joint Clinical Consensus Statement on Enhanced Recovery After Urogynecologic Surgery

“…An RCT concluded that preoperative regional pudendal block with a combination of liposomal and plain bupivacaine provided more effective vaginal pain control than plain bupivacaine alone for reconstructive surgery that included posterior colporrhaphy 82 but, if injected into the lateral posterior vaginal wall and perineal body, does not provide a significant decrease in postoperative pain or decrease narcotic medication usage compared to saline 83 . However, in midurethral sling and laparoscopic surgery, there was no benefit of liposomal bupivacaine compared to saline or bupivacaine for improving pain control or reducing opioid use 84,85 . Due to the additional cost of liposomal bupivacaine, studies are necessary to determine the cost-benefit ratio 62,86 …”

“…83 However, in midurethral sling and laparoscopic surgery, there was no benefit of liposomal bupivacaine compared to saline or bupivacaine for improving pain control or reducing opioid use. 84,85 Due to the additional cost of liposomal bupivacaine, studies are necessary to determine the cost-benefit ratio. 62,86 Recommendation Incisional infiltration of local anesthetics and transversus abdominis plane block has no systemic side effects when used appropriately and is recommended at the time of surgery for minimally invasive gynecology as well as vulvar and vaginal surgery.…”

The effect of liposomal bupivacaine for surgical wound infiltration: A meta‐analysis of randomised controlled trials

“…During the full‐text screening process, 52 citations were excluded for the following reasons: irrelevant comparator or intervention (n = 7), did not report wound infiltration (n = 24), not being an RCT (n = 18), lack of available data (n = 2), or being an animal study (n = 1). Twenty‐two studies were included in this meta‐analysis 15‐18,28‐45 . A flow diagram of the study selection process is shown in Figure 1.…”