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Liposomal bupivacaine incisional block at the time of cesarean delivery to decrease post-operative pain: a randomized controlled trial
Abstract Number: T1A-1
Abstract Type: Original Research
Objective: To evaluate whether liposomal bupivacaine (LB) incisional block decreases postoperative pain and represents an opioid-sparing strategy after scheduled cesarean delivery (CD).
Methods: In a single-blinded, randomized controlled trial among opioid naïve women undergoing CD, LB or placebo was infiltrated into the fascia and skin at the surgical site, prior to fascial closure. Randomization was stratified by CD type: primary vs. repeat. All women received neuraxial anesthesia and neuraxial morphine, and postoperative pain management was with NSAIDs, acetaminophen, and oral opioids as needed. Using an 11-point numerical rating scale, the primary outcome was pain score with movement at 48 hours postoperatively. A sample size of 40 women per group was needed to detect a 1.5-point reduction in pain score in the intervention group. Pain scores and opioid consumption, in oral morphine milligram equivalents (MME), were summarized as medians (interquartile range, IQR) and compared using the Wilcoxon rank sum test.
Results: Between March and September 2017, 249 women were screened, 103 women enrolled, and 80 women randomized. One woman in the LB group was excluded after randomization due to a vertical skin incision, leaving 39 patients in the LB group and 40 in the placebo group. Baseline characteristics between groups were similar. The median (IQR) pain score with movement at 48 hours postoperatively was 4 (2-5) in the LB group and 3.5 (2-5.5) in the placebo group, p=0.72 (Table). The median (IQR) opioid use was 37.5 (7.5-60) MME in the LB group and 37.5 (15-75) MME in the placebo group during the first 48 hours postoperatively, p=0.44. 61.5% of patients in the LB group and 57.5% of patients in the placebo group (p=0.93) perceived their intervention as having been LB. No adverse outcomes associated with local anesthetic toxicity were noted in this trial, and wound complications occurred among 2 patients in the placebo group, and 1 patient in the LB group.
Conclusion: Compared with placebo, LB incisional block at the time of CD resulted in similar postoperative pain scores in the first 48 hours postoperatively. No differences in opioid consumption, post-operative length of stay, or patient satisfaction were observed.