Department of Anesthesiology and Perioperative Medicine, Maine Medical Center, Portland, Maine, USA.
Spectrum Healthcare Partners, South Portland, Maine, USA.
Pain Pract. 2024 Jun;24(5):717-723. doi: 10.1111/papr.13347. Epub 2024 Jan 24.
Transversus abdominis plane blocks are an established method of postoperative analgesia for abdominopelvic surgeries. Liposomal bupivacaine is an extended-release formulation of bupivacaine providing up to 72 h of analgesia. This study aims to determine if transversus abdominis plane blocks performed with liposomal bupivacaine are associated with reduced opioid consumption and level of pain intensity compared to conventional bupivacaine in patients undergoing lower abdominal surgery.
This retrospective cohort study was conducted at a single institution between December 2020 and December 2021. After institutional review board approval, we identified patients who underwent lower abdominopelvic surgery with transversus abdominis plane blocks done with liposomal or conventional bupivacaine and collected demographic, clinical, and procedural information for analysis. We compared total opioid consumption over 72-h postoperatively in milligram morphine equivalents (MME), frequency of opioid utilization, and average level of pain intensity between groups. These outcomes were also evaluated after adjusting for covariates. Data were presented as mean ± SD, median [IQR] or frequency (%), as appropriate; p < 0.05 was accepted as significant.
A total of 178 patients met inclusion criteria, with 79 patients receiving an admixture of liposomal bupivacaine and conventional bupivacaine and 99 patients receiving conventional bupivacaine. The liposomal bupivacaine group had a median opioid consumption 72-h postoperatively of 47.5 [18-91.8] MME compared to 88 [43.8-160] MME in the conventional bupivacaine group, p = 0.045. Differences in opioid consumption between the groups did not reach statistical significance after adjustment for demographic and clinical characteristics, p = 0.11. There was no significant difference in frequency of opioid use or average pain intensity.
Transversus abdominis plane blocks using an admixture of liposomal bupivacaine conventional bupivacaine are not associated with decreased opioid consumption or reduced pain up to 72 h following elective abdominopelvic surgery.
腹横肌平面阻滞是腹部和骨盆手术后一种成熟的术后镇痛方法。脂质体布比卡因是布比卡因的一种延长释放制剂，可提供长达 72 小时的镇痛效果。本研究旨在确定与传统布比卡因相比，在接受下腹部手术的患者中，使用脂质体布比卡因进行腹横肌平面阻滞是否与减少阿片类药物消耗和疼痛强度水平相关。
这是一项在 2020 年 12 月至 2021 年 12 月在一家单机构进行的回顾性队列研究。在机构审查委员会批准后，我们确定了接受下腹部腹横肌平面阻滞术的患者，这些阻滞术使用脂质体或传统布比卡因进行，并收集了分析用的人口统计学、临床和程序信息。我们比较了术后 72 小时内以吗啡等效剂量（MME）表示的总阿片类药物消耗、阿片类药物使用频率和平均疼痛强度水平。在调整协变量后，也对这些结果进行了评估。数据以均值±标准差、中位数[IQR]或频率（%）表示，p＜0.05 为有统计学意义。
共有 178 名患者符合纳入标准，其中 79 名患者接受了脂质体布比卡因和传统布比卡因的混合物，99 名患者接受了传统布比卡因。脂质体布比卡因组术后 72 小时的阿片类药物消耗量中位数为 47.5 [18-91.8] MME，而传统布比卡因组为 88 [43.8-160] MME，p=0.045。在调整人口统计学和临床特征后，两组之间的阿片类药物消耗差异没有达到统计学意义，p=0.11。阿片类药物使用频率或平均疼痛强度无显著差异。
在择期腹部和骨盆手术后，使用脂质体布比卡因和传统布比卡因混合物的腹横肌平面阻滞术与减少阿片类药物消耗或减轻疼痛无关，持续时间长达 72 小时。
