Postlaparotomy pain management: Comparison of patient-controlled analgesia pump alone, with subcutaneous bupivacaine infusion, or with injection of liposomal bupivacaine suspension.

Autor:	Yalmanchili HM; Resident, Department of Surgery, Mount Carmel Health System, Columbus, Ohio., Buchanan SN; Resident, Department of Surgery, Mount Carmel Health System, Columbus, Ohio., Chambers LW; Attending, Program Director (Surgery), Department of Surgery, Mount Carmel Health System, Columbus, Ohio., Thorns JD; Resident, Department of Surgery, Mount Carmel Health System, Columbus, Ohio., McKenzie NA; Resident, Department of Surgery, Mount Carmel Health System, Columbus, Ohio., Reiss AD; Resident, Department of Surgery, Mount Carmel Health System, Columbus, Ohio., Page MP; Attending, Department of Surgery, Mount Carmel Health System, Columbus, Ohio., Dizon VV; Attending, Department of Surgery, Mount Carmel Health System, Columbus, Ohio., Brooks SE; Research Nurse, Department of Research Affairs, Mount Carmel Health System, Columbus, Ohio., Shaffer LE; Senior Statistical Analyst, Department of Research Affairs, Mount Carmel Health System, Columbus, Ohio., Lovald ST; Biostatistician, Exponent, Inc., Menlo Park, California., Hartranft TH; Attending, Former Program Director (Surgery), Department of Surgery, Mount Carmel Health System, Columbus, Ohio., Price PD; Attending, Department of Surgery, Mount Carmel Health System, Columbus, Ohio.
Jazyk:	angličtina
Zdroj:	Journal of opioid management [J Opioid Manag] 2019 Mar/Apr; Vol. 15 (2), pp. 169-175.
DOI:	10.5055/jom.2019.0498
Abstrakt:	Objective: Efforts to achieve balance between effective pain management and opioid-related adverse events (ORAEs) have led to multimodal analgesia regimens. This study compared opioids delivered via patient-controlled analgesia (PCA) plus liposomal bupivacaine, a long-acting local anesthetic with potential to be an effective component of such regimens, to opioids delivered through PCA alone or PCA plus subcutaneous bupivacaine infusion (ONQ), following laparotomy. Design: Prospective, randomized controlled trial. Setting: Single, tertiary-care institution. Patients: One hundred patients undergoing nonemergent laparotomy. Interventions: Patients were randomly assigned to one of three study treatments: PCA only (PCAO), PCA with ONQ, or PCA with injectable liposomal bupivacaine suspension (EXP). Main Outcome Measures: Cumulative opioid use, daily mean patient-reported pain scores, and ORAEs through 72 hours postoperatively. Results: On average, the EXP (n = 31) group exhibited less than 50 percent of the total opioid consumption of the PCAO (n = 36) group, and less than 60 percent of that for the ONQ (n = 33) group. Postoperative days 1 and 3 pain scores were significantly lower for the EXP group as compared to the ONQ and PCAO groups (p ≤ 0.005). Fewer patients in the EXP group (19.4 percent) experienced ORAEs compared to the PCAO (41.1 percent) and ONQ (45.5 percent) groups (p = 0.002). Conclusions: Laparotomy patients treated with liposomal bupivacaine as part of a multimodal regimen consumed less opioids, had lower pain scores, and had fewer ORAEs. The role of liposomal bupivacaine in the postoperative care of laparotomy patients merits further study.
Databáze:	MEDLINE
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