Featured Article| Volume 223, ISSUE 5, P832-838, May 2022

Pain management after laparoscopic appendectomy: Comparative effectiveness of innovative pre-emptive analgesia using liposomal bupivacaine

Published:September 23, 2021DOI:


      • 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.



      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.


      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.


      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).


      Pre-emptive analgesia with LB during laparoscopic appendectomy can reduce inpatient opioid use without significantly increasing post-operative pain scores.


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