Oral Presentation
A Randomized Trial of Wound Infiltration with Extended-Release versus Short-Acting Bupivacaine Before Laparoscopic or Robotic-Assisted Hysterectomy

https://doi.org/10.1016/j.jmig.2016.08.008Get rights and content

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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.

. Postoperative pain scores during the first 24 hours from surgery, numeric rating scale ± standard deviation.

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