Liposomal Bupivacaine Addition Versus Standard Bupivacaine Alone for Colorectal Surgery: A Randomized Controlled Trial

Abstract

Aim: This study evaluated use of liposomal bupivacaine (LB) versus standard bupivacaine (SB) alone in quadratus lumborum (QL) blocks for laparoscopic colorectal surgery. Materials & methods: In this prospective, randomized controlled trial, patients received QL1 blocks with either LB (40 ml 0.125% SB plus 20 ml of LB) or SB (60 ml of 0.25% SB) with 30 ml per side. Opioid usage, pain scores, side effects and other medications were recorded. Results: For 78 patients (38 LB; 40 SB), all parameters were similar between groups, except that the LB group had a higher 48 h need for metoclopramide. Conclusion: LB provided no analgesic benefit over SB alone for QL blocks. Clinical Trials registration number: NCT03702621

PROcedure-SPECific postoperative pain management guideline for laparoscopic colorectal surgery

“…Two studies failed to demonstrate analgesic superiority of liposomal bupivacacine over a mixture of bupivacaine–epinephrine–dexamethasone in TAP blocks, 86 or standard bupivacaine in QLB 87 …”

“…Some studies had more than two relevant study arms. These were separately listed for each relevant comparison, making the sum of studies in the following listing higher than the number of studies included: seven studies investigating adjuvant systemic analgesics, 39–45 three studies investigating varying degrees of neuromuscular blockade, 46–48 seven studies investigating intravenous lidocaine, 43,49–54 six studies investigating epidural analgesia, 55–60 four studies investigating spinal opioids, 55,61–63 twenty-eight studies investigating truncal nerve blocks, 53,58–60,64–87 seven studies investigating wound infiltration, 54,57,72–74,88,89 four studies investigating intraperitoneal local anaesthetics (IPLA) 90–93 and seventeen studies investigating surgical techniques 94–110 . Supplemental Table 1, http://links.lww.com/EJA/A901 lists the summary of key results from studies evaluating systemic analgesics, systemic analgesic adjuncts, regional analgesia and surgical procedures used to support the recommended interventions in patients after laparoscopic colectomy.…”

“…Two studies failed to demonstrate analgesic superiority of liposomal bupivacacine over a mixture of bupivacaine-epinephrine-dexamethasone in TAP blocks, 86 or standard bupivacaine in QLB. 87 In conclusion, truncal blocks (TAP, QLB, ESPB) are not recommended as a first-line analgesic method in laparoscopic colorectal surgery because of inconsistent procedure-specific evidence. TAP blocks may possibly offer clinical benefits if an additional incision is created (handassisted surgery).…”

The postoperative analgesic efficacy of liposomal bupivacaine versus long-acting local anaesthetics for peripheral nerve and field blocks

“…18,21,23,26,27 Trial characteristics Table 1 presents the trial characteristics. Eleven trials included patients undergoing orthopaedic surgery, 18,20,24,[27][28][29]32,33,35,36,38 six others included patients undergoing breast or gynaecological surgery, 21,23,26,30,34,44 six trials included patients undergoing abdominal surgery 22,25,31,37,41,43 and four trials included patients who underwent other types of surgery. 19,39,40,42 Fifteen trials investigated the efficacy of liposomal bupivacaine on peripheral nerve blocks, [18][19][20][21]24,[27][28][29]32,33,36,[38][39][40]42 while 12 explored its efficacy on field...…”

“…Baessler et al, 18 Dawes et al, 20 Dengler et al, 21 Fafaj et al, 22 Fidkowski et al, 23 Flaherty et al, 24 Hubler et al, 28 Hungerford et al, 29 Hutchins et al, 30 Hutchins et al, 31 Kim et al, 32 Purcell et al, 35 Simovitch et al, Truong et al, 37 Vandepitte et al, 38 Weksler et al, 40 Xie et al 42 , Yeap et al 43 694 720 -2.5 [-5.8 to 0.9] 97 0.13…”