Liposomal bupivacaine infiltration into the transversus abdominis plane for postsurgical analgesia in open abdominal umbilical hernia repair: results from a cohort of 13 patients

Abstract

BackgroundAchieving adequate control of postsurgical pain remains a challenge in patients undergoing abdominal surgery. Transversus abdominis plane (TAP) infiltration has been shown to provide postsurgical analgesia following lower abdominal surgery. We assessed the safety and efficacy of a prolonged-release liposomal formulation of the local anesthetic bupivacaine administered via infiltration into the TAP in a cohort of patients undergoing open abdominal umbilical hernia repair.MethodsPatients included in the study were 18–75 years of age, had American Society of Anesthesiologists physical classification status 1–3, and underwent open abdominal umbilical hernia repair with ultrasound-guided TAP infiltration immediately after surgery using an equal-volume bilateral infusion of liposomal bupivacaine 266 mg (diluted to 30 mL in normal saline). Outcome measures included patient-reported pain intensity (11-point numeric rating scale), satisfaction with postsurgical analgesia (5-point Likert scale), incidence of opioid-related adverse events, and time to first use of supplemental rescue analgesia.ResultsThirteen patients underwent surgery and received bilateral TAP infiltration with liposomal bupivacaine; TAP infiltration failed in the first patient. Mean numeric rating scale pain scores were 0.6 immediately before TAP infiltration and remained ≤2.3 through 120 hours after infiltration; mean scores at 120 hours and 10 days were 0.9 and 0.4, respectively. Ten patients (77%) required supplemental analgesia; median time to first use was 11 hours. At discharge and day 10, 54% and 62% of patients, respectively, were “extremely satisfied” with postsurgical analgesia (Likert score 5). There were no opioid-related or other adverse events.ConclusionAlthough the current study was limited by both its lack of a control group and its small size, to our knowledge, it is the first published report on use of liposomal bupivacaine for TAP infiltration. In this cohort, liposomal bupivacaine was observed to be well tolerated with encouraging analgesic efficacy.

Ultrasound-guided subcostal transversus abdominis plane blocks with liposomal bupivacaine vs. non-liposomal bupivacaine for postoperative pain control after laparoscopic hand-assisted donor nephrectomy: a prospective randomised observer-blinded study

“…In addition to our previous study, which showed decreased total opioids in the first 72 h after robotic hysterectomy [11], other studies have evaluated liposomal bupivacaine for TAP infiltration. Feierman et al showed in a small prospective cohort that liposomal bupivacaine could be used in a TAP infiltration without adverse events [17]. Likewise, in our study, there were no indications of local anaesthetic toxicity in either study group.…”

Ultrasound guided subcostal transversus abdominis plane (TAP) infiltration with liposomal bupivacaine for patients undergoing robotic assisted hysterectomy: A prospective randomized controlled study

“…Liposomal bupivacaine (EXPAREL®; Pacira Pharmaceuticals, Inc.; Parsippany, NJ, USA) is a multivesicular liposomal formulation of 1.3% bupivacaine, which provides up to 72 h of postoperative pain control in wound and TAP infiltration techniques [11,12]. It is a liposome technology where the reorganization of the triglycerides in the external lipid layer leads to release of the bupivacaine from within the vesicle.…”

Evaluation of the Efficacy of Liposomal Bupivacaine Infiltrated into the Posterior Capsule for Postoperative Analgesia after Total Knee Arthroplasty—A Randomized Double Blind Clinical Trial

“…Assuming a difference of at least three points on an eleven-point pain scale from 0 to 10 NRS pain scale and a standard deviation (SD = 2.2 [16]), the effect size is expected to be at least 1.36 with a sample of 10 in each group (Group A and Group B) that should provide 82% power to detect a significant difference with alpha = 0.05. The time course of mean pain scores from 4 to 72 hours postopera-Open Journal of Anesthesiology tively was analyzed using mixed model regression.…”