Does liposomal bupivacaine use intraoperatively decrease postoperative narcotic use in radical cystectomy patients?

Abstract

311 Background: Bupivacaine liposome injectable suspension (LB) can be used to help control postoperative pain. It slowly releases bupivacaine for up to 96 hours after injection. This study sought to determine if the use of LB intraoperatively for radical cystectomy (RC) patients decreases postoperative narcotic use. Methods: A retrospective cohort study was performed. 281 patients underwent RC between November 2013 and May 2016, 203 received LB. LB was administered after fascial closure but before skin closure by performing suprafascial and subfascial injection with 20ml of LB. Patient demographics, BMI, renal function, operative characteristics, and the total postoperative intravenous morphine equivalents were reviewed. Where appropriate chi-squared, Mann-Whitney and t-tests were used for statical analysis. Multivariable analysis and linear regression models were performed. Because enhanced recovery principles were used simultaneously, enhanced recovery status was also used to adjust for predictors of post-operative opioid use. Results: There was no difference in baseline demographics, BMI, renal function or baseline opioid use between the LB and non-LB group. The operative time was longer in those who had LB administered and there were more open RCs performed in the LB group. Total morphine equivalents averaged to 8.0 mgs for the LB group and 50.7 mgs for the non-LB group, p-value <0.001. More patients had epidurals and IV PCA pumps in the non-LB group, (p=0.001 and <0.001, respectively). There were 42 patients whom did not require any IV morphine equivalents in the LB group compared to only 4 in the non-LB group (p=0.002). After adjusting for modality, and operative time, the linear regression model was predictive of less IV morphine equivalents in those with LB, p=0.044. Conclusions: The addition of LB to enhanced recovery principles increases the number of patients with zero narcotic use postoperatively. Irrespective of open or robotic modality and operative time, LB use decreases opioid use after RC.