Transversus Abdominis Plane Blocks in Laparoscopic Colorectal Surgery: Better Pain Control and Patient Outcomes with Liposomal Bupivacaine than Bupivacaine

Abstract

Transversus abdominis plane (TAP) blocks are a safe and effective way to provide immediate postoperative pain relief in surgical patients, and have been shown to decrease narcotic requirements. Concerns about complications of narcotics, increase in hospital length of stay (LOS), and health-care costs make this of particular interest. We compared standard bupivacaine TAP blocks with those carried out using liposomal bupivacaine to evaluate postoperative outcomes. Fifty patients undergoing elective laparoscopic colectomy received laparoscopic liposomal bupivacaine TAP blocks using 80 cc of local anesthetic, and data were collected prospectively during hospitalization. Data collected included amount of narcotic medication used during hospitalization, number of days to ambulation, number of days to bowel function, and LOS. These patients were compared with the last 50 patients recruited to the control/bupivacaine TAP block arm of the study. The same data parameters were collected and all patients were on an enhanced recovery protocol, which included scheduled acetaminophen, ibuprofen, and gabapentin by mouth, as well as clear liquid diet starting on postoperative day zero. Statistical analysis was performed using Student's t test and Fisher's exact test; P < 0.05 was considered statistically significant. Patients treated with liposomal bupivacaine needed less narcotics (5.06 vs 18.75 mg, P = 0.0002), had earlier bowel function (1.7 vs 2.4 days, P = 0.0002), and shorter LOS (2.7 vs 3.4 days, P = 0.0146). Patients undergoing laparoscopic colon resections seem to require fewer narcotics and have better patient outcomes with liposomal bupivacaine TAP blocks. Based on our data, liposomal bupivacaine seems to be superior to bupivacaine for TAP blocks.

Preoperative Versus Postoperative Use of Transversus Abdominis Plane Block With Nonliposomal Bupivacaine on Postoperative Narcotic Use: A Retrospective Study.

“…Liposomal bupivacaine, an extended-release version, increases the duration of action of plain bupivacaine [9]. Past industry sponsored studies have shown liposomal bupivacaine to be more effective than plain bupivacaine in controlling pain after colectomy, resulting in fewer narcotics use, faster return of bowel function, and shorter length of stay [16][17][18]. However, in a non-sponsored, prospective, randomized double-blind clinical trial, Knudson et al found no signi cant difference in hydromorphone PCA use in the rst 2 postoperative days for patients who received liposomal vs plain bupivacaine after colorectal resections [19].…”

Transversus Abdominis Plane Block With Liposomal Bupivacaine vs. Regular Anesthetics for Pain Control After Surgery: A Systematic Review and Meta-Analysis

“…One important variable that may limit a more liberal use of LB is its high cost. While some studies report that the better and prolonged pain control offered by LB reduces hospital stay and in turn compensates for the cost of the drug (33,35), the same has not been duplicated by other clinicians (46,47). Beachler et al (47) have indicated that given the minimal clinical benefits of LB and the substantial cost of the drug, its use is not justifiable in total hip arthroplasty patients.…”

“…Ten were excluded as per the reasons mentioned in Table 1 (20)(21)(22)(23)(24)(25)(26)(27)(28)(29). A total of seven studies were included in this systematic review and meta-analysis (30)(31)(32)(33)(34)(35)(36). Details of the included studies are presented in Table 2.…”

“…All studies were conducted in the United States. Five studies were RCTs (30)(31)(32)(33)(34), one was a prospective (35), while another was a retrospective study of a prospectively collected database (36). Ultrasound (US) guidance was used for the TAP blocks in four studies (30,33,34,36).…”

“…Except for the studies of Wong et al (31) and Ha et al (32), which did not report any statistically significant difference in total analgesic consumption between the two groups, all studies reported significantly lower consumption of analgesics in the LB group at some time interval. Except for the study of Guerra et al (35), all studies included pain scores as one of their outcomes. Hutchins et al (34) did not report the numerical or graphical data on pain scores in their article, while Nedeljkovic et al (30) did not report data as mean and SD.…”