Gynecologic Abdominal Surgery: Liposomal Bupivacaine May Reduce Opioid Use

Liposomal bupivacaine administered in a transversus abdominis plane (TAP) block does not decrease hospital length of stay compared with bupivacaine hydrochloride (HCl) — but does decrease postoperative opioid use — among patients undergoing gynecologic abdominal surgery, according to a presentation at the 2018 Society of Gynecologic Oncology Annual Meeting on Women’s Cancer in New Orleans.¹

For this prospective study, researchers randomly assigned 120 patients to receive bupivacaine HCl or liposomal bupivacaine. Eligible patients had a gynecologic malignancy and were to undergo exploratory laparotomies, and signed consent forms to receive TAP block prior to surgery. Patients under 18 years, undergoing minimally invasive surgery, pregnant, or those who had contraindications to either study medication were excluded from the study.

Of the enrolled 120 patients, 117 received study interventions — 51 and 66 patients received bupivacaine HCl and liposomal bupivacaine, respectively — and were evaluable at the time of analysis.

Patients who received bupivacaine HCl had a median length of stay of 2.08 days vs 2.93 days for patients who received liposomal bupivacaine for TAP block.

The median total opioid use, however, was 56.25 vs 37.50 morphine milligram equivalents (MME) for patients treated with bupivacaine HCl vs liposomal bupivacaine, respectively.

The authors concluded that “this study offers a potential way to decrease postoperative narcotic use and fits well into the Enhanced Recovery After Surgery goals in the field of gynecologic oncology. Understanding that opioid use postoperatively is associated with increased risk of abuse and addiction, our intervention presents an opportunity to improve outcomes and prevent abuse.”

Read more of Cancer Therapy Advisor‘s coverage of the Society of Gynecologic Oncology 2018 meeting by visiting the conference page.

Reference

1. Ching H, Atkins RF, Burton ER, Edelson MI, Sorosky JI, Shahin MS. A comparison of liposomal bupivacaine to bupivacaine HCI in tranversus abdominis planus block for abdominal gynecologic surgery: a randomized controlled trial. Oral presentation at: 2018 Society of Gynecologic Oncology Annual Meeting on Women’s Cancer; March 24-27, 2018; New Orleans, LA.