Journal of Minimally Invasive Gynecology
Oral PresentationA Randomized Trial of Wound Infiltration with Extended-Release versus Short-Acting Bupivacaine Before Laparoscopic or Robotic-Assisted Hysterectomy
Section snippets
Study Objective
To evaluate if pre-incision infiltration with extended-release liposomal bupivacaine provides improved pain relief after laparoscopic or robotic-assisted total hysterectomy compared to 0.25% bupivacaine.
Design
Triple-masked randomized controlled trial; patients followed for 14 days postoperatively.
Setting
Tertiary-care community hospital.
Patients
Patients recruited from July 2015 through January 2016. Sixty-four patients were randomized and 60 were analyzed for the primary outcome.
Intervention
Women scheduled to undergo multiport laparoscopic or robotic-assisted total hysterectomy for benign indications were randomized to receive pre-incision infiltration with either undiluted liposomal bupivacaine or 0.25% bupivacaine.
Measurements and Main Results
The primary outcome was pain intensity by a numeric rating scale (0-10) using the Brief Pain Inventory (BPI) via telephone survey on postoperative days (POD) 1, 2, 3 and 14. A sample size of 28 per group (N=56) was planned to detect a 30% change in pain scores. Secondary outcomes were numeric pain scores while inpatient, pain interference as measured by the BPI, total opioid use, and adverse effects. There were no demographic differences between the two groups. For our primary outcome, there
Conclusion
For laparoscopic and robotic-assisted multiport hysterectomy there were decreased post-operative pain scores with pre-incisional liposomal bupivacaine compared to 0.25% bupivacaine on POD3 only, and no difference in opioid use, pain interference scores, or reported adverse effects. These findings indicate limited effectiveness of liposomal bupivacaine for laparoscopic hysterectomy.