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Transversus Abdominis Plane Block With Liposomal Bupivacaine for Pain Control After Cesarean Delivery: A Retrospective Chart Review
Abstract Number: T3B-5
Abstract Type: Original Research
Many women experience moderate-to-severe pain for ≥48 hours postcesarean section. Multimodal postsurgical pain management seeks to reduce reliance on opioids, which are associated with adverse effects negatively impacting ambulation, lactation, breastfeeding, and maternal-infant bonding, and pose risk for chronic use. Regional anesthesia using transversus abdominis plane (TAP) block reduces opioid usage and improves analgesia postcesarean . Liposomal bupivacaine (LB), a prolonged-release bupivacaine formulation, reduces postcesarean opioid usage when infiltrated at the incisional site . This single-center retrospective chart review evaluated the safety and effectiveness of multimodal pain management with or without LB TAP block for cesarean delivery. It included deidentified records from 201 consecutive patients (multimodal pain management with LB, n=101; multimodal pain management without LB, n=100) ≥18 years who delivered under anesthesia by Dr. Baker between 2012 and 2015. Endpoints included postsurgical opioid consumption (morphine equivalent dose); area under the curve (AUC; day 0–3) of numeric rating scale pain intensity scores (range, 0 [no pain] to 10 [worst possible pain]); time to discharge readiness from the postanesthesia care unit (PACU); discharge location; time to ambulation, solid food, and bowel movement; hospital length of stay (LOS); and adverse events (AEs). Outcomes were compared between groups using Wilcoxon, chi-square, and Student t tests. Results are summarized in the Table. Multimodal pain management with LB significantly reduced overall mean postsurgical opioid consumption by 47% (P<0.001) and mean AUC of pain scores by 46% (P<0.001) compared with multimodal pain management without LB. Patients treated with LB had a significantly shorter mean PACU-ready time (138 vs 163 min, P=0.028) and average LOS (2.9 vs 3.9 days; P<0.001). LB significantly decreased mean times to ambulation and solid food by 39% and 31%, respectively (P<0.01, each), and numerically reduced mean time to bowel movement (26%; P=0.05). Fewer patients treated with vs without LB reported an AE (34% vs 50%; P=0.026). These data suggest that a multimodal pain management approach incorporating LB TAP block can reduce opioid reliance and improve pain management and recovery after cesarean delivery.
Funding: Pacira Pharmaceuticals
1. Abdallah FW, et al. Br J Anaesth. 2012;109(5):679-687.
2. Parikh P, et al. J Matern Fetal Neonatal Med. 2017:1-5.