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Incisional liposomal bupivacaine and its impact on post cesarean analgesia.
Abstract Number: T-56
Abstract Type: Original Research
Introduction: Appropriate postoperative pain control after cesarean delivery is very important as the mother attempts to recuperate postoperatively and provide care for her newborn. Existing analgesic modalities have effects lasting up to 24hrs. In addition, they have unwanted side effects such as nausea, vomiting, pruritis, urinary retention, sedation and respiratory depression, which are barriers in providing care for a newborn. Long acting local anesthetics such as liposomal bupivacaine may have prolonged analgesic effects lasting 72-96hours. Our goal is to investigate the effectiveness of incisional liposomal bupivacaine injection in reducing post-cesarean morphine use in women undergoing primary cesarean via a Pfannenstiel incision.
Methods: This is a retrospective, case-control study with a 1:1 allocation ratio of study cases to controls. All the cesarean deliveries at a community hospital in Mississippi spanning a 40-month period from 2011 to 2014 completed by a single physician were reviewed and 80 cases meet the inclusion criteria. Study group received an injection of 266mg of liposomal bupivacaine in the space between the rectus muscle and fascia, and at the level of the subcutaneous tissue; divided equally. None of the patients received intrathecal morphine. Data about type of anesthesia administered, opioid consumption, non-steroidal anti-inflammatory use, acetaminophen use, type of cesarean, reason for cesarean and length of post-operative stay were collected.
Results: A multiple linear regression model was used to determine the statistical significance. There is a significant difference of IV morphine use between the study and the control group; 26.52 milligrams (p=<0.001, 95% CI of 12.76mg to 40.28mg). Administration of intravenous ketorolac and acetaminophen was greater in treatment group compared to control group (p< 0.001, p<0.001), but this was controlled for in the final analysis. Post-operative length of stay was similar between groups (p=0.475). The indication for cesarean, number of classical surgeries, type of anesthesia (GETA, spinal, epidural) were not different between groups (p=0.583).
Conclusions: This study supports the injection of liposomal bupivacaine into Pfannenstiel incisions as an analgesic adjunct in reducing post-operative opioid usage, in patients undergoing primary cesarean delivery. Further study is recommended in the form of a prospective trial that includes pain scores and return of bowel function.