Kalogera Eleftheria, Bakkum-Gamez Jamie N, Weaver Amy L, Moriarty James P, Borah Bijan J, Langstraat Carrie L, Jankowski Christopher J, Lovely Jenna K, Cliby William A, Dowdy Sean C
Division of Gynecologic Surgery, the Division of Biomedical Statistics and Informatics, the Department of Health Sciences, Division of Health Care Policy and Research & Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, the Department of Anesthesiology, and the Hospital Pharmacy Service, Mayo Clinic, Rochester, Minnesota.
Obstet Gynecol. 2016 Nov;128(5):1009-1017. doi: 10.1097/AOG.0000000000001719.
To investigate opioid use and pain scores associated with incisional injection of liposomal bupivacaine compared with bupivacaine hydrochloride after laparotomy for gynecologic malignancies.
A retrospective cohort study was conducted to compare abdominal incision infiltration with liposomal bupivacaine with bupivacaine hydrochloride after modification of a pre-existing enhanced recovery pathway. Patients undergoing staging laparotomy or complex cytoreductive surgery under the updated pathway were compared with patients treated under the original pathway (historic controls). Endpoints included cumulative opioid use (primary outcome) in oral morphine equivalents and cumulative pain score.
In the complex cytoreductive cohort, median oral morphine equivalents were lower in the liposomal bupivacaine group through 24 hours (30 compared with 53.5 mg, P=.002), 48 hours (37.5 compared with 82.5 mg, P=.005), and the length of stay (62 compared with 100.5 mg, P=.006). Fewer liposomal bupivacaine patients required intravenous rescue opioids (28.9% compared with 55.6%, P<.001) or patient-controlled analgesia (4.1% compared with 33.3%, P<.001). Cumulative pain score was no different between groups through 48 hours (161 compared with 158, P=.69). Postoperative nausea and ileus were less frequent in patients receiving liposomal bupivacaine. Median hospital stay was 5 days in both groups. In the staging laparotomy cohort, cumulative opioids and cumulative pain score were no different between groups (through 48 hours: 162 compared with 161, P=.62; 38 compared with 38, P=.68, respectively). Intravenous rescue opioids (15.3% compared with 28.6%, P=.05) and patient-controlled analgesia (1.4% compared with 8.3%, P=.05) were used less frequently in the liposomal bupivacaine group. Median hospital stay was 4 days in both groups. Despite the higher cost of liposomal bupivacaine, total pharmacy costs did not differ between groups.
Abdominal incision infiltration with liposomal bupivacaine was associated with less opioid and patient-controlled analgesia use with no change in pain scores compared with bupivacaine hydrochloride after complex cytoreductive surgery for gynecologic malignancies. Improvements were also seen in patients undergoing staging laparotomy.
探讨妇科恶性肿瘤剖腹手术后，与盐酸布比卡因相比，切口注射脂质体布比卡因时的阿片类药物使用情况及疼痛评分。
进行一项回顾性队列研究，在对预先存在的强化康复路径进行修改后，比较脂质体布比卡因与盐酸布比卡因对腹部切口的浸润效果。将在更新路径下接受分期剖腹手术或复杂细胞减灭术的患者与在原始路径下接受治疗的患者（历史对照）进行比较。观察指标包括口服吗啡当量的累积阿片类药物使用量（主要结局）和累积疼痛评分。
在复杂细胞减灭术队列中，脂质体布比卡因组在术后24小时（分别为30mg和53.5mg，P = 0.002）、48小时（分别为37.5mg和82.5mg，P = 0.005）及住院期间（分别为62mg和100.5mg，P = 0.006）的口服吗啡当量中位数较低。使用静脉补救性阿片类药物的脂质体布比卡因患者较少（分别为28.9%和55.6%，P < 0.001），或使用患者自控镇痛的患者较少（分别为4.1%和33.3%，P < 0.001）。两组在48小时内的累积疼痛评分无差异（分别为161和158，P = 0.69）。接受脂质体布比卡因的患者术后恶心和肠梗阻的发生率较低。两组的中位住院时间均为5天。在分期剖腹手术队列中，两组的累积阿片类药物使用量和累积疼痛评分无差异（术后48小时内：分别为162和161，P = 0.62；分别为38和38，P = 0.68）。脂质体布比卡因组使用静脉补救性阿片类药物（分别为15.3%和28.6%，P = 0.05）和患者自控镇痛（分别为1.4%和8.3%，P = 0.05）的频率较低。两组的中位住院时间均为4天。尽管脂质体布比卡因成本较高，但两组的药房总费用无差异。
与妇科恶性肿瘤复杂细胞减灭术后使用盐酸布比卡因相比，脂质体布比卡因浸润腹部切口与阿片类药物和患者自控镇痛使用减少相关，且疼痛评分无变化。在接受分期剖腹手术的患者中也观察到了改善。
