One Type of Bupivacaine Is Better Postsurgery

Using liposomal bupivacaine to control pain in patients after gynecological surgery reduced the amount of narcotics needed and may lead to faster recovery times, a recent study found.

In the study, which included about 400 surgical patients, researchers compared the efficacy of liposomal bupivacaine and bupivacaine hydrochloride (HCl) for controlling postoperative pain after laparotomy for gynecological malignancies. Sean C. Dowdy, MD, clinical director for the National Surgical Quality Improvement Program for the Department of Surgery at Mayo Clinic, presented the results at the annual meeting of the Society of Gynecologic Surgeons.

Key Finding:

- The use of liposomal bupivacaine, compared with use of bupivacaine HCl, following gynecologic surgery decreased the need for narcotics and reduced the use of patient-controlled analgesia.

Bupivacaine HCl treats pain for about 6 to 8 hours, whereas liposomal bupivacaine works for multiple days. Unsurprisingly, the researchers found that patients who received liposomal bupivacaine following complex cytoreductive surgery required significantly fewer doses of intravenous opioids during the first and second postoperative days than those whose pain was managed with bupivacaine HCl. They also continued to use less opioids for the remainder of their hospitalization. The median stay was 5 days.

During the first day following surgery, 21.5% of the patients treated with liposomal bupivacaine required opioids, while 46.9% of patients who received bupivacaine HCI were given opioids to control pain. By day two, just 7.4% of patients treated with liposomal bupivacaine were given opioids compared with 27.2% in the other group.

Still, the researchers also found that the pain scores were the same between the two groups.

Similarly, when the researchers looked at opioid use among women who underwent staging laparotomy, they found that pain scores were similar between those who received liposomal bupivacaine and those who were given bupivacaine HCl. However, they also found that the cumulative opioid use didn’t differ between the two cohorts.

Still, the data pointed to a reduction in use of patient-controlled analgesia among those who were treated with liposomal bupivacaine (1.4% vs 8.3%, P=.05). This was also found among women who underwent cytoreductive surgeries, with 4.1% of the women treated with liposomal bupivacaine using patient-controlled analgesia compared with 33.3% of women in the control group.

The research is part of an ongoing post-operative approach at the Mayo Clinic to get patients eating, drinking, and walking faster. By limiting narcotic use, the researchers believe common adverse effects, such as constipation and nausea, are reduced, allowing for a speedier recovery.

Data from the Mayo Clinic study was presented during the annual meeting of the Society of Gynecologic Surgeons.