Highlights
- •Restricting post-operative opioid analgesia may lower the risk of opioid abuse.
- •Liposomal Bupivacaine (LB) may sustain pain control better than common local anesthetics.
- •Intraoperative LB use may reduce opioid consumption but maintain pain control.
- •This retrospective cohort study compared three LB regimens to a non-LB cohort.
- •LB cohorts had lower opioid use after laparoscopic appendectomy without increased pain.
Abstract
Background
Laparoscopic appendectomy is standard of care for appendicitis in the US. Pain control
that limits opioids is an important area of research given the opioid epidemic. This
study examined post-appendectomy inpatient opioid use and pain scores following intraoperative
use of liposomal bupivacaine (LB) versus non-liposomal bupivacaine.
Methods
This was a retrospective cohort study of 155 adults who underwent laparoscopic appendectomy
for acute appendicitis. Patients were divided into four cohorts based on the analgesia
administered: (i) bupivacaine hydrochloride (BH)± epinephrine; (ii) undiluted LB;
(iii) LB diluted with normal saline; and (iv) LB diluted with BH.
Results
Baseline demographic/clinical attributes, intra-operative findings, and post-operative
pain scores were equivalent across cohorts. Post-operative pre-discharge opioid use
was higher in the BH vs. LB cohorts (mean 60.4 vs. 46.0, 35.5, and 30.4 morphine milligram
equivalents, respectively; p < 0.001).
Conclusions
Pre-emptive analgesia with LB during laparoscopic appendectomy can reduce inpatient
opioid use without significantly increasing post-operative pain scores.
Keywords
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Article info
Publication history
Published online: September 23, 2021
Accepted:
September 20,
2021
Received in revised form:
September 6,
2021
Received:
June 2,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
