Kenneth I Barron1, Georgine M Lamvu2, R Cole Schmidt3, Matthew Fisk3, Emily Blanton3, Insiyyah Patanwala3. 1. Division of Advanced and Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, University of Virginia School of Medicine, Charlottesville, Virgnia. Electronic address: kenneth.barron.md@gmail.com. 2. Department of Obstetrics and Gynecology, University of Central Florida College of Medicine, Orlando, Florida; Division of Surgery, Gynecology Section, Orlando Veterans Affairs Medical Center, Orlando, Florida. 3. Department of Obstetrics and Gynecology, Florida Hospital Graduate Medical Education, Florida Hospital Orlando, Orlando, Florida; Department of Obstetrics and Gynecology, University of Central Florida College of Medicine, Orlando, Florida.
Abstract
STUDY OBJECTIVE: To evaluate if preincision infiltration with extended-release liposomal bupivacaine provides improved overall pain relief compared with 0.25% bupivacaineafter laparoscopic or robotic-assisted hysterectomy. DESIGN: A single-center double-masked randomized controlled trial (Canadian Task Force Classification I). SETTING: A tertiary-care community hospital. PATIENTS: Patients recruited from July 2015 through January 2016. Sixty-four patients were randomized, and 59 were analyzed for the primary outcome. INTERVENTIONS: Women scheduled to undergo multiport laparoscopic or robotic-assisted total hysterectomy for benign indications were randomized to receive preincision infiltration with undiluted liposomal bupivacaine or 0.25% bupivacaine. MEASUREMENTS AND MAIN RESULTS: The primary outcome was overall average pain intensity by numeric rating scale (0-10) using the Brief Pain Inventory (BPI) via telephone survey on postoperative day (POD) 3. A sample size of 28 per group (N = 56) was planned to detect a 30% change in pain scores. Secondary outcomes were overall average and worst numeric pain scores on PODs 1, 2, and 14; pain scores in hospital; BPI pain interference scores; and total opioid use. There were no demographic differences between the 2 groups. For the primary outcome, we found a decrease in the average (p = .02) pain scores on POD 3 in the liposomal bupivacaine group. We also found a decrease in worst pain scores on POD 2 (p = .03) and POD 3 (p = .01). There were no differences in pain scores while in the hospital or on POD 1 or POD 14. There were no differences in BPI pain interference scores, opioid use, or reported adverse effects. CONCLUSION: For laparoscopic and robotic-assisted multiport hysterectomies, there is evidence of decreased average postoperative pain with liposomal bupivacaine compared with 0.25% bupivacaine for port-site analgesia on POD 3, but no difference in opioid use or measures of functioning. Published by Elsevier Inc.
RCT Entities:
STUDY OBJECTIVE: To evaluate if preincision infiltration with extended-release liposomal bupivacaine provides improved overall pain relief compared with 0.25% bupivacaine after laparoscopic or robotic-assisted hysterectomy. DESIGN: A single-center double-masked randomized controlled trial (Canadian Task Force Classification I). SETTING: A tertiary-care community hospital. PATIENTS: Patients recruited from July 2015 through January 2016. Sixty-four patients were randomized, and 59 were analyzed for the primary outcome. INTERVENTIONS:Women scheduled to undergo multiport laparoscopic or robotic-assisted total hysterectomy for benign indications were randomized to receive preincision infiltration with undiluted liposomal bupivacaine or 0.25% bupivacaine. MEASUREMENTS AND MAIN RESULTS: The primary outcome was overall average pain intensity by numeric rating scale (0-10) using the Brief Pain Inventory (BPI) via telephone survey on postoperative day (POD) 3. A sample size of 28 per group (N = 56) was planned to detect a 30% change in pain scores. Secondary outcomes were overall average and worst numeric pain scores on PODs 1, 2, and 14; pain scores in hospital; BPI pain interference scores; and total opioid use. There were no demographic differences between the 2 groups. For the primary outcome, we found a decrease in the average (p = .02) pain scores on POD 3 in the liposomal bupivacaine group. We also found a decrease in worst pain scores on POD 2 (p = .03) and POD 3 (p = .01). There were no differences in pain scores while in the hospital or on POD 1 or POD 14. There were no differences in BPI pain interference scores, opioid use, or reported adverse effects. CONCLUSION: For laparoscopic and robotic-assisted multiport hysterectomies, there is evidence of decreased average postoperative pain with liposomal bupivacaine compared with 0.25% bupivacaine for port-site analgesia on POD 3, but no difference in opioid use or measures of functioning. Published by Elsevier Inc.
Entities:
Keywords:
Hysterectomy; Laparoscopy; Local anesthesia; Postoperative pain; Robotics
Authors: Jacob Hutchins; Peter Argenta; Aaron Berg; Jason Habeck; Alexander Kaizer; Melissa A Geller Journal: J Pain Res Date: 2019-07-04 Impact factor: 3.133