Infiltration of Liposome Bupivacaine into the Transversus Abdominis Plane for Postsurgical Pain Management in a 39-Year-Old Female Undergoing Laparoscopic Cholecystectomy

Abstract

Pain after laparoscopic cholecystectomy is reportedly complex and multifaceted, and has been cited as the most frequent reason for prolonged convalescence. The use of opioid therapy, a common pain management strategy, can be limited by potentially severe adverse events. In this report, I describe the use of liposome bupivacaine, administered via transversus abdominis plane (TAP) infiltration, in a patient undergoing emergency laparoscopic cholecystectomy. The patient underwent an emergency laparoscopic cholecystectomy complicated by an unexpected correction of partially detached mesh implanted during prior ventral hernia repair. The patient was discharged to the post-anesthesia care unit, but reported a pain score of 8 (11-point scale; 10 = worst possible pain). Fentanyl rescue therapy failed to alleviate the pain. Liposome bupivacaine was administered via bilateral TAP infiltration as postsurgical rescue pain medication, part of a multimodal analgesic regimen. The patient tolerated the TAP infiltration well and subsequently reported a pain score of 2 and a pain satisfaction score of 10 (11-point scale; 10 = completely satisfied). No additional analgesics were required. The patient was discharged on postoperative day 1, resumed normal activities in <24 hours, and remained satisfied with the pain management for 5 days. TAP infiltration of liposome bupivacaine was associated with improvement in postsurgical pain control, eliminated the need for additional opioids, and reduced the length of hospital stay from the usual 3 days to <24 hours. Liposome bupivacaine administered via TAP infiltration shows potential as part of a multimodal analgesic regimen in laparoscopic cholecystectomy.