When included in an enhanced recovery pathway for cytoreductive gynecologic surgery, local infiltration of liposomal bupivacaine was associated with reductions in the need for rescue intravenous opioids and patient-controlled analgesia (PCA), as well as reductions in ileus.1
In complex operations with laparotomy, the use of liposomal bupivacaine “will reduce the need for total narcotics use, reduce the need for intravenous narcotics, and also reduce nausea,” Sean Dowdy, MD, FACS, professor and chair of the Division of Gynecologic Surgery at the Mayo Clinic in Rochester, MN, told Cancer Therapy Advisor.
Enhanced recovery after surgery (ERAS) is a multispecialty, best-practice pathway developed to enhance recovery after major surgery. Much of the evidence for ERAS involves colorectal surgery and has been tied to a shorter hospital stay and fewer postoperative complications, which may lead to cost benefits as well.2
A review of the evidence for ERAS in gynecologic oncology demonstrated its safety with associated reductions in length of stay and cost. Perioperative ERAS interventions for gynecologic oncology included aggressive vomiting and nausea prevention, early ambulation, maintenance of euvolemia, and reduction in intravenous opioids.3
Dr Dowdy and colleagues sought to add to the evidence of enhanced recovery pathways by investigating the efficacy of surgical site infiltration with liposomal bupivacaine (LB) compared to bupivacaine HCL (BH).1
Liposomal bupivacaine is a multivesicular liposomal encapsulated bupivacaine formulated for slow, sustained release of the analgesic.4
Dr Dowdy explained to Cancer Therapy Advisor that the control group (BH) had been “optimized through a perioperative care pathway. So we had already incorporated enhanced recovery and we showed pretty significant improvements with length of stay.”
In this group of patients receiving major surgery for ovarian cancer that included a laparotomy, the “length of stay went from 8 days to 5 days” and “the use of PCA went from 100% to 30% and we had an 80% reduction in the use of narcotics,” he said.