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Liposomal Bupivacaine Block at the Time of Cesarean Delivery to Decrease Postoperative Pain: A Randomized Controlled

Malavika Prabhu1, Mark A Clapp, Emily McQuaid-Hanson

  • 1Division of Maternal-Fetal Medicine and the Deborah Kelly Center for Outcomes Research, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts; Providence Anesthesia Services, Spokane, Washington; and the Department of Anesthesia, Critical Care, and Pain Medicine and the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, and the Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.

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Liposomal bupivacaine incisional blocks did not significantly reduce postoperative pain or opioid use in women undergoing cesarean delivery. This study found no difference in pain scores or opioid consumption between the liposomal bupivacaine and placebo groups at 48 hours.

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Area of Science:

  • Anesthesiology
  • Obstetrics
  • Pain Management

Background:

  • Cesarean delivery often involves significant postoperative pain, necessitating effective pain management strategies.
  • Opioid analgesics are commonly used but carry risks of side effects and dependence.
  • Liposomal bupivacaine offers prolonged local anesthesia, potentially reducing the need for systemic opioids.

Purpose of the Study:

  • To determine if a liposomal bupivacaine incisional block reduces postoperative pain after cesarean delivery.
  • To assess the efficacy of liposomal bupivacaine as an opioid-sparing strategy in this patient population.

Main Methods:

  • A single-blind, randomized controlled trial was conducted involving opioid-naive women undergoing cesarean delivery.
  • Liposomal bupivacaine or placebo was infiltrated into the surgical site fascia and skin before closure.
  • Pain scores with movement at 48 hours postoperatively were the primary outcome, assessed using an 11-point numeric rating scale.

Main Results:

  • Eighty women were randomized (39 liposomal bupivacaine, 40 placebo).
  • The median pain score with movement at 48 hours was 4 (interquartile range [IQR], 2-5) in the liposomal bupivacaine group and 3.5 (IQR, 2-5.5) in the placebo group (P=.72).
  • Median opioid use at 48 hours was 37.5 (IQR, 7.5-60) morphine milligram equivalents for liposomal bupivacaine and 37.5 (IQR, 15-75) for placebo (P=.44).

Conclusions:

  • Liposomal bupivacaine incisional blocks did not result in significantly lower postoperative pain scores compared to placebo at 48 hours after cesarean delivery.
  • The use of liposomal bupivacaine did not demonstrate an opioid-minimizing effect in this study population.
  • Further research may be needed to explore alternative applications or patient groups for liposomal bupivacaine in obstetric anesthesia.