Liposomal Bupivacaine Research Articles

Percutaneous endoscopic gastrostomy in amyotrophic lateral sclerosis: outcomes of a dedicated anesthesia and surgery protocol.

Patients requiring percutaneous endoscopic gastrostomy (PEG) for amyotrophic lateral sclerosis (ALS) related dysphagia represent a clinical challenge. Diminished pulmonary function and aspiration risks can lead to anesthesia-related complications, and gastric displacement from hemidiaphragm elevation may preclude safe gastric access. This study reports the efficacy and outcomes of a dedicated anesthesia/surgery management protocol for ALS patients undergoing PEG. In 2013, a PEG placement protocol for ALS patients was developed emphasizing efficient pre-operative evaluation, rapidly metabolized anesthetic agents, and minimization of opioid use. Outcomes were analyzed retrospectively. Preoperative weight loss, pulmonary function tests, total analgesia, procedural time, and 90-day morbidity and mortality were recorded. From 2013-2019, 67 ALS patients (mean age 65.3years, 52.2% female) received a PEG under the protocol. Mean percentage weight loss 6months before PEG was 9.3 ± 5.1% with 38.8% of patients meeting criteria for severe malnutrition. Mean anesthesia time (propofol induction to anesthesia emergence) was 34.5 ± 10.8min and mean operative time (endoscope insertion to dressing placement) was 16.4 ± 8.2min. Regional anesthesia with liposomal bupivacaine was performed in 76.1%. All attempts at PEG placement were successful. With a mean follow-up of 6.1 ± 6.8months, all PEGs were functional and there were no surgical site complications. Thirty-day readmission rate was 7.0% and 90-day mortality was 22.4% (46.7% occurring within 30days). Mean time from surgery to death was 8.8 ± 7.8months. Protocols for optimizing PEG may help overcome challenges present in the ALS patient population. Despite patient comorbidities, protocol implementation and dedicated team members resulted in a high procedural success rate and low complication rate. Further study is warranted to optimize the timing of PEG placement in relation to ALS disease progression and determine the utility of regional anesthesia during PEG placement.

Safety and Efficacy of Liposomal Bupivacaine Supraclavicular Nerve Blocks in Open Treatment of Distal Radius Fractures: A Perioperative Pain Management Protocol.

Distal radius fractures (DRFs) are common fractures requiring surgical fixation. The literature varies regarding opioid prescribing habits, opioid consumption, and postoperative pain scores. We hypothesized that the preoperative administration of a liposomal bupivacaine (LB) supraclavicular nerve block would be safe and effective in controlling postoperative pain. A standardized pain management protocol was implemented at a single institution from July 2021 to March 2022 for patients undergoing open reduction internal fixation of DRF. Protocol elements included a preoperative LB supraclavicular nerve block and a multimodal postoperative pain regimen. Primary clinical outcomes included postoperative pain scores and number of opioid tablets consumed. Twenty patients underwent a newly implemented protocol. The average age was 56 years. Mean number of oxycodone 5-mg tablets consumed was 4.1 (median, 2.5), and mean visual analog scale pain score at first postoperative appointment was 2.8. There were no incidences of missed acute carpal tunnel postoperatively. When compared with an institutional historical control (n = 189), number of opioid pills prescribed was reduced by 60% (21.4 vs 8.6 tablets, P < 0.0001), and no patients had unscheduled health care contact because of uncontrolled pain (22% vs 0%, P < 0.016). Liposomal bupivacaine supraclavicular nerve blocks are safe and effective in the treatment of postoperative pain after open reduction internal fixation of DRF. Patients consumed <5 oxycodone tablets on average, which is less than many recommend prescribed quantities (>20-30 tablets). Patients had low pain scores (2.8/10) at the first postoperative follow-up. To our knowledge, this is the first study demonstrating the utility of LB in this clinical setting.

Liposomal bupivacaine is both safe and effective when administered via local infiltration at surgical site and mesovarium for laparoscopic ovariectomy in mares.

Liposomal local anaesthetic solutions may provide extended-duration analgesia postoperatively but have not been assessed following intra-peritoneal local infiltration in any species. To evaluate two doses of 1.33% liposomal bupivacaine (LB) versus 0.75% bupivacaine HCL (BHCl) for analgesia following laparoscopic ovariectomy in mares. Prospective cohort study. Fifteen healthy Quarter Horse mares (age 2-20 years) with normal bilateral ovarian palpation and appearance were enrolled. Horses were restrained in standing stocks and administered an α-2 agonist, butorphanol, and flunixin meglumine, followed by a variable rate infusion of sedation with α-2 agonists. Bilateral paralumbar fossa ovariectomies were performed. Treatment with either 30 ml 0.75% BHCl followed by 20 or 40 ml LB 13.3% (LB20 and LB40) volume expanded with saline to 80 ml total (n=6/group) or 80 ml BHCl alone (n=3, BCHL) was infused around incision sites and each mesovarium (LB or BHCl) prior to ovariectomy. Horses were monitored for 72 h by physical examination, algometry, and pain scoring (composite pain scale by Bussieres et al., Horse Grimace Scale). Abdominocentesis with peritoneal fluid analysis was performed at 72 h. Analgesia achieved with all treatment protocols allowed completion of ovariectomy procedures. Pressure algometry scores were lower in BHCl-treated horses versus both LB groups overall. Pain scores were improved with LB-treated horses in a dose-dependent fashion (Horse Grimace Scale scores LB40 < LB20 < BHCL; composite pain scale scores LB40 < BHCL, LB20 < BHCL, BHCL, and LB20 did not differ). Peritoneal fluid total protein was lower in LB40 versus LB20 and BHCL horses. No complications from LB administration were appreciated. Small patient sample size, lack of follow-up past 72 h or histopathology. Analgesia duration was extended and pain scores improved postoperatively with LB versus BHCl in a dose-dependent fashion. Further clinical evaluation of extended-duration local anaesthetics in horses for improved postoperative pain management is warranted.

Abdominal and robotic sacrocolpopexy costs following implementation of enhanced recovery after surgery.

To compare perioperative costs and morbidity between open and robotic sacrocolpopexy after implementation of enhanced recovery after surgery (ERAS) pathway. The present retrospective cohort study of patients undergoing open or robotic sacrocolpopexy (January 1, 2014, through November 30, 2017) used an ERAS protocol with liposomal bupivacaine infiltration of laparotomy incisions. Primary outcomes were costs associated with index surgery and hospitalization, determined with Medicare cost-to-charge ratios and reimbursement rates and adjusted for variables expected to impact costs. Secondary outcomes included narcotic use, length of stay (LOS), and complications from index hospitalization to postoperative day 30. For the total of 231 patients (open cohort, 90; robotic cohort, 141), the adjusted mean cost of robotic surgery was $3239 higher compared with open sacrocolpopexy (95% confidence interval [CI] $1331-$5147; P < 0.001). Rates were not significantly different for intraoperative complications (robotic, 4.3% [6/141]; open, 5.6% [5/90]; P=0.754), 30-day postoperative complications (robotic, 11.4% [16/141]; open, 16.7% [15/90]; P=0.322), or readmissions (robotic, 5.7% [8/141]; open, 3.3% [3/90]; P=0.535). The percentage of patients dismissed on postoperative day 1 was greater in the robotic group (89.4% [126/141] vs. 48.9% [44/90], P < 0.001). Decreased LOS associated with ERAS provided significant cost savings with open sacrocolpopexy versus robotic sacrocolpopexy without adverse impacts on perioperative complications or readmissions.

Comparative growth dynamics of bacterial and fungal contaminants in liposomal bupivacaine, bupivacaine 0.5%, and propofol

Introduction: Bupivacaine liposomal injectable suspension (BLIS) provides local analgesia for up to 72 hours. Multiple vial punctures over consecutive days have been suggested as a cost-effective, extra-label handling strategy. It is unknown, however, if BLIS supports microbial growth when extrinsically contaminated.

Histomorphometric parameters as indicators of nerve tissue damage after perineural and intraneural application of liposomal bupivacaine in rat model

Histomorphometric parameters as indicators of nerve tissue damage after perineural and intraneural application of liposomal bupivacaine in rat model

Paraspinal regional analgesic techniques in spine surgery−a narrative review

Patients undergoing spine surgeries may experience intense postoperative pain and its related complications such as increased opioid use and delayed early ambulation. Therefore, adequate perioperative pain management is important to promote patient’s recovery. In addition, many patients often present with pre-existing chronic pain and opioid use. Although regional analgesic techniques are widely used in other surgical fields, the use of this modality for spine surgery is still evolving. This review article discusses the use of regional analgesic techniques for pain management during spine surgeries. Specifically, we will review fascial plane blocks including erector spinae plane block, retrolaminar block, transversus abdominis plane block, thoracolumbar interfascial plane block, modified thoracolumbar interfascial plane block, multifidus cervicis plane block, and superficial cervical plexus block. In addition, the use of liposomal bupivacaine is discussed. Regional analgesic techniques are described as part of multimodal analgesia regimens and show promising analgesic effects and favorable outcomes in spine surgery. However, the results from the most recent articles revealed only a short-term and limited benefit. Further well-designed studies with greater sample sizes are needed to clarify the effects of regional analgesic techniques on perioperative pain management, including long-term benefits.

Liposomal Bupivacaine is not Clinically Superior to a Standard Bupivacaine Mixture for Interscalene Nerve Block for Postoperative Pain Control in Shoulder Arthroplasty/Arthroscopy, but may Still be Beneficial

Liposomal Bupivacaine is not Clinically Superior to a Standard Bupivacaine Mixture for Interscalene Nerve Block for Postoperative Pain Control in Shoulder Arthroplasty/Arthroscopy, but may Still be Beneficial

Does Liposomal Bupivacaine Decrease Postoperative Opioid Use in Conjunction with an Enhanced Recovery After Bariatric Surgery Pathway? A Prospective, Double-blind, Randomized Controlled Trial

Minimization of opiate use is an important focus in the setting of the severe national opioid crisis. This study evaluated the role of liposomal bupivacaine (LB) in decreasing postoperative opioid use before and after implementation of a bariatric enhanced recovery after surgery (ERAS) program. We performed an IRB-approved, prospective, double-blind, randomized controlled trial of LB versus plain bupivacaine (PB) in patients undergoing elective, minimally invasive, weight loss surgery at a comprehensive metabolic and bariatric surgery program from November 2017 to December 2019. Primary outcomes were postoperative morphine milligram equivalents per day (MME/day) and average subjective inpatient pain level. Secondary outcomes were length of hospital stay (LOS) and adverse events (AEs). Of the 100 patients enrolled, 78 were randomly assigned to LB (42) or PB (36). Thirty-four received the ERAS protocol, and 44 did not. The mean MME/day use did not differ significantly by the bupivacaine group [median, IQR PB: 20.3 (40.95); LB: 33.0 (42.9); p = .314], but it did differ by the ERAS group [median, IQR no ERAS 33.2 (47.1), ERAS 24.0 (34.0); p = .049]. Length of stay, inpatient pain score, and AEs did not differ significantly by either the bupivacaine or the ERAS group. In our study, liposomal bupivacaine did not significantly decrease postoperative opioid use either before implementation of ERAS or as part of an enhanced recovery after surgery program for minimally invasive bariatric surgery procedures.

1107: EVALUATION OF LIPOSOMAL BUPIVACAINE VERSUS USUAL CARE AND ITS EFFECT ON PAIN FOR CARDIAC SURGERY

Introduction: The objective of this study is to compare clinical effects of standard of care and liposomal bupivacaine. The primary outcome of this study will be to compare the pain scores associated with liposomal bupivacaine compared to standard of care of standard bupivacaine. Methods: A prospective, randomized, single-blinded, active-controlled, parallel group trial was conducted on cardiac surgery evaluating opioid analgesic consumption and effectiveness of pain control in patients who received liposomal bupivacaine vs. bupivacaine/epinephrine. The study was conducted at a 503-bed tertiary care community hospital. Participants included patients of at least 18 years of age undergoing a cardiac surgical procedure at the study institution. The standard of care group received 0.25% bupivacaine with epinephrine at 1 mL/kg total dose and the treatment arm received liposomal bupivacaine 266 mg/20 ml added to 40 ml 0.25% bupivacaine with epinephrine. Both treatment arms received either therapy as a single-dose infiltration from the first to the 8th intercostal space. Results: A total of 43 patients received liposomal bupivacaine and 44 patients received bupivacaine/epinephrine. The difference in average opioid (morphine equivalent) usage between liposomal bupivacaine and bupivacaine/epinephrine on post-operative (POD) day 1 was 11 mg (IQR 5.25-24.3 mg) and 14 mg (IQR 5-26.175 mg) and on POD 4, the difference was 1.5 mg (IQR 0-4.875) and 0 mg (IQR 0-3). There was no difference in average pain scores and adverse effects between the two groups. Conclusions: The results of this current study found that the administration of liposomal bupivacaine intra-operatively cardiac surgery show less opioid use as compared to the standard of care. The study is ongoing and enrolling more patients.

Liposomal Bupivacaine Versus Continuous Nerve Block: Liposomal Bupivacaine May be Non-inferior and More Cost Effective

BackgroundRegional anesthesia with adductor canal block has become the standard of care for pain management after total knee arthroplasty (TKA). We hypothesized that liposomal bupivacaine (LB) may be noninferior to continuous nerve block with a pain pump in terms of average pain scores, 30- and 90-day readmissions, and emergency department (ED) visits while reducing cost. MethodsA retrospective chart review was performed on primary TKA patients from 2015 to 2020 by 23 orthopaedic surgeons at a single institution. The inclusion criteria was treatment with LB or a pain pump, and exclusion criteria was receipt of both anesthetics and revision surgery. A total of 2,378 patients met the inclusion criteria with 1,640 patients treated with LB and 738 treated with the pain pump. Demographic differences were not statistically significant. Primary outcomes were average pain scores, 30- and 90-day readmissions, and ED visits. Secondary outcomes were average milligram morphine equivalents per admission, hospital lengths of stay , and costs. ResultsThere was no significant difference in pain scores on postoperative days 0, 1, 2, or 3 (P = .77, .86, 0.08, and 0.40, respectively), 30- or 90- day readmissions (P = .527 and P = .374), ED visits (P = .129 and P = .108), milligram morphine equivalents utilizations (P = .194), or average hospital LOS (P = .348). We estimated a potential cost savings of $95 per patient and $155,800 over the course of the study. ConclusionLB was found to be noninferior to a pain pump, and the transition to this medication was associated with cost savings.

Clinical Outcomes of Liposomal Bupivacaine Erector Spinae Block in Minimally Invasive Transforaminal Lumbar Interbody Fusion Surgery.

Postoperative pain is a barrier to early mobility and discharge after lumbar surgery. Liposomal bupivacaine (LB) has been shown to decrease postoperative pain and narcotic consumption after transforaminal lumbar interbody fusions (TLIFs) when injected into the marginal suprafascial/subfascial plane-liposomal bupivacaine (MSSP-LB). Erector spinae plane (ESP) infiltration is a relatively new analgesic technique that may offer additional benefits when performed in addition to MSSP-LB. To evaluate postoperative outcomes of combining ESP-LB with MSSP-LB compared with MSSP-LB alone after single-level TLIF. A retrospective analysis was performed for patients undergoing single-level TLIFs under spinal anesthesia, 25 receiving combined ESP-LB and MSSP-LB and 25 receiving MSSP-LB alone. The primary outcome was length of hospitalization. Secondary outcomes included postoperative pain score, time to ambulation, and narcotics usage. Baseline demographics and length of surgery were similar between groups. Hospitalization was significantly decreased in the ESP-LB + MSSP-LB cohort (2.56 days vs 3.36 days, P = .007), as were days to ambulation (0.96 days vs 1.29 days, P = .026). Postoperative pain area under the curve was significantly decreased for ESP-LB + MSSP-LB at 12 to 24 hours (39.37 ± 21.02 vs 53.38 ± 22.11, P = .03) and total (44.46 ± 19.89 vs 50.51 ± 22.15, P = .025). Postoperative narcotic use was significantly less in the ESP-LB + MSSP-LB group at 12 to 24 hours (13.18 ± 4.65 vs 14.78 ± 4.44, P = .03) and for total hospitalization (137.3 ± 96.3 vs 194.7 ± 110.2, P = .04). Combining ESP-LB with MSSP-LB is superior to MSSP-LB alone for single-level TLIFs in decreasing length of hospital stay, time to ambulation, postoperative pain, and narcotic use.

Comparison of Femoral Nerve Catheter, Adductor Canal Catheter, and Periarticular Liposomal Bupivacaine Infiltration for Postoperative Analgesia After Primary Total Knee Arthroplasty

BackgroundPeripheral nerve catheters are used to provide analgesia after total knee arthroplasty (TKA) and have been shown to decrease pain and opioid use, to facilitate participation with physical therapy (PT), and to hasten discharge. More recently, pericapsular infiltration using liposomal bupivacaine (LB) has been employed as an alternative analgesic approach. MethodsThis retrospective study compared outcomes for three analgesic approaches: femoral nerve catheter (FNC), adductor canal catheter (ACC), and intraoperative LB infiltration. The primary outcome was numeric rating scale (NRS) pain scores at 24 hours. Secondary outcomes included pain scores at 12, 36, and 48 hours, time-to-first opioid, cumulative opioid use, distance walked, and time-to-discharge. ResultsPain scores at 24 hours were significantly lower in both the ACC and FNC cohorts when compared to the LB cohort (3.1 versus 4.6 [P = .017] and 2.4 versus 4.6 [P < .0001]). The ACC and FNC groups did not differ significantly at that timepoint (P = .27). Similar comparisons were found at 12 and 36 hours, while at 48 hours the FNC group was superior. Time to first opioid and opioid consumption favored the ACC and FNC groups. Walking distance favored the ACC group. Both the ACC and LB groups had a faster time-to-discharge than the FNC group. ConclusionBoth ACCs and FNCs provided superior analgesia at 24 hours compared to LB, while being equivalent to each other. Pain scores at 12 hours and 36 hours as well as opioid consumption through 48 hours mirrored this finding. Although various differences were found between groups in terms of time-to-first analgesic, walking distance and time-to-discharge, the ACC approach appeared to optimally balance analgesia, ambulation, and time-to-discharge.

Safety and short-term outcomes of anatomic vs. reverse total shoulder arthroplasty in an ambulatory surgery center.

A scarcity of literature exists comparing outcomes of outpatient anatomic (aTSA) and reverse total shoulder arthroplasty (rTSA). This study was performed to compare early outcomes between the 2 procedures in a freestanding ambulatory surgery center (ASC) and to determine if the addition of preoperative interscalene nerve block (ISNB) with periarticular liposomal bupivacaine injection (PAI) in the postanesthesia care unit (PACU) would improve outcomes over PAI alone. Medical charts of all patients undergoing outpatient primary aTSA or rTSA at 2 ASCs from 2012 to 2020 were reviewed. Atotal of 198 patients were ultimately identified (117 aTSA and 81 rTSA) to make up this retrospective cohort study. Patient demographics, PACU outcomes, complications, readmissions, reoperations, calls to the office, and unplanned clinic visit rates were compared between procedures. PACU outcomes were compared between those receiving ISNB with PAI and those receiving PAI alone. Patients undergoing rTSA were older (61.1 vs. 55.7 years, P<.001) and more likely to have American Society of Anesthesiologists (ASA) class 3 (51.9% vs. 41.0%, P=.050) compared to patients having aTSA. No patient required an overnight stay. Time in the PACU before discharge (89.1 vs. 95.6 minutes, P=.231) and pain scores at discharge (3.0 vs. 3.0, P=.815) were similar for aTSA and rTSA, respectively. One intraoperative complication occurred in the aTSA group (posterior humeral circumflex artery injury) and 1 in the rTSA group (calcar fracture) (P=.793). Ninety-day postoperative total complication (7.7% vs. 7.4%), shoulder-related complication (6.0% vs. 6.2%), medical-related complication (1.7% vs. 1.2%), admission (0.8% vs. 2.5%), reoperation (2.6% vs. 1.2%), and unplanned clinic visit (6.0% vs. 6.1%) rates were similar between aTSA and rTSA, respectively (P≥.361 for all comparisons). At 1 year, there were 8 reoperations and 15 complications in the aTSA group compared with 1 reoperation and 8 complications in the rTSA group (P=.091 and P=.818, respectively). Patients who had ISNB spent less time in PACU (75 vs. 97 minutes, P<.001), had less pain at discharge (0.2 vs. 3.9, P<.001), and consumed less oral morphine equivalents in the PACU (1.2 vs. 16.6 mg, P<.001). Early postoperative outcomes and complication rates were similar between the 2 groups, and all patients were successfully discharged home the day of surgery. The addition of preoperative ISNB led to more efficient discharge from the ASC with less pain in the PACU.

Efficacy of Liposomal Bupivacaine in Arthroscopic Rotator Cuff Repair: a Systematic Review and Meta-Analysis of Randomized Controlled Trials

Efficacy of Liposomal Bupivacaine in Arthroscopic Rotator Cuff Repair: a Systematic Review and Meta-Analysis of Randomized Controlled Trials

Risk factors for early returns to care following same-day discharge primary shoulder arthroplasty

BackgroundUnderstanding who is most likely to return to care following same-day discharge (SDD) shoulder arthroplasty might improve our understanding of the indications for home recovery. Therefore, we sought to identify risk factors for early returns to care following same-day shoulder arthroplasty. MethodsPatients aged ≥18 years who underwent a primary shoulder arthroplasty and were discharged on the same day as their procedure were identified using a health care system’s shoulder arthroplasty registry (2009-2020). The outcome of most interest was early returns to care, defined as an emergency department visit or readmission within 1 day and 2 days of the discharge date. Factors associated with returns in univariable logistic regression with P < .1 were included in the final multivariable model where a P < .05 was the threshold for statistical significance. ResultsThe study cohort included 3666 SDD shoulder arthroplasty. Of the final sample, 93 (2.5%) and 144 (3.9%) patients returned to care within 1 day and 2 days after discharge, respectively. Patients with a history of chronic pulmonary disease had a higher likelihood of returning to care within 1 day, while the addition of liposomal bupivacaine or single-shot regional anesthesia when compared to continuous catheter anesthesia associated with a lower likelihood of return. Patients with a history of neurological disorders had a higher likelihood of return within 2 days. Patients with a history of peptic ulcer disease/bleeding had a higher likelihood of return within 1 day and 2 days postoperative, while an operative start time of noon or later and a longer operative time were associated with a lower likelihood at both time points. ConclusionLess than 4% of patients in a large integrated health care system experienced a return to care within 2 days of SDD shoulder arthroplasty. Risk factors for returns varied depending on the window evaluated with some medical comorbidities and continuous catheters associated with a higher likelihood of early returns.

What's New in Adult Reconstructive Knee Surgery.

What's New in Adult Reconstructive Knee Surgery.

Optimizing the use of liposomal bupivacaine in shoulder arthroplasty

BackgroundShoulder arthroplasty (SA) is the fastest growing joint replacement surgery in the United States, and it has been estimated that postoperative pain management is not adequately controlled in up to 80% of patients. Liposomal bupivacaine (LB) has been included as part of the multimodal pain management that has shown promise in reducing pain, narcotic consumption, and hospital length of stay in SAs, but there has been some controversy regarding its efficacy in the literature. This may be due to lack of standardization across studies in the utilization of LB or the lack of efficacy of local LB infiltration. The purpose of this study was to identify whether there is an optimal dilution of LB required for maximal analgesia after SA in order to direct future literature and increase the strength of evidence for recommendations in clinical practice. MethodsA retrospective review of prospectively collected data was conducted with patients undergoing primary SA categorized into 40 mL, 60 mL, or 80 mL dilutions of 20 mg of LB with 0.9% normal saline. Patient-reported pain scores and opioid consumption were collected at days 1, 3, 7, and 30 postoperatively. Dependence rates were reported and defined as three months of continuous opioid use. Opioid consumption was calculated using total morphine equivalents (TME), and an analysis of variance was performed to compare outcomes between groups. ResultsSeventy-four patients were identified and divided into one of three groups based on the dilution of LB received intraoperatively. There were significant differences in pain scores between the groups on day 7 postoperatively with the 80 mL group having significantly lowest pain scores (P = .012). No significant difference in opioid consumption was found between the groups during any time point. There was a trend toward fewer opioids over the study period in the 80 mL group relative to other groups. Overall, all dilution groups resulted in low TME and postoperative pain after the 30-day study period. ConclusionAll three dilution groups achieved excellent pain control and minimal opioid usage following SA. The 80 mL dilution group showed lower pain scores at day 7 postoperatively and trended toward less opioid consumption in the first 30 days. Our study suggests that, overall, orthopedic surgeons can consider using all three LB dilutions as an effective and safe option for pain management after an SA.

The effect of liposomal bupivacaine for surgical wound infiltration: A meta-analysis of randomised controlled trials.

Liposomal bupivacaine (LB) has consistently been considered a potential analgesic for surgical wound infiltration. However, the evidence of its analgesic effectiveness remains unclear. In this meta-analysis, we attempted to identify the potential clinical role of LB wound infiltration in different surgical procedures. Randomised controlled trials (RCTs) comparing LB with non-liposomal local anaesthetics and placebos were retrieved from six electronic databases. The primary outcome was cumulative morphine equivalent consumption within 24, 48, and 72 hours after surgery. Approximately 2659 patients from 22 studies were included in the meta-analysis. Compared to the control, LB-wound infiltration did not reduce the postoperative morphine consumption at 24 hours (weighted mean difference [WMD], -0.60 mg; 97.5% confidence interval [CI], -2.78 to 1.59 mg; P=0.54), 48 hours (WMD, -1.00 mg; 97.5% CI, -3.23 to 1.24; P=0.32) or 72 hours (WMD, 0.50 mg; 97.5% CI, -0.67 to 1.67; P=0.33). Similarly, secondary outcome analysis did not reveal any additional benefits of LB in any other pain-related outcomes. LB was not associated with any adverse effects. Overall, LB does not appear to improve the postoperative analgesic, rehabilitation, or safety outcomes. Current evidence does not support the routine use of LB for wound infiltration following surgical procedures.

Abstract 11768: Reducing the Burden of the Opioid Epidemic by Adopting a Novel Pain Control Strategy Utilizing Pectoral Nerve Block in Adults Undergoing Transvenous Cardiac Device Implants

Introduction: Despite early mitigation efforts, the opioid pandemic in the United States has persisted and affected many Americans. A public health emergency was declared regarding opioid prescriptions. Alternative approaches to postoperative pain control after transvenous cardiac device implants (TCDI) in adults have not been described. Methods: We report a single center retrospective analysis of 153 consecutive patients that underwent TCDI from January to August 2021 with ultrasound guided pectoral nerve block (PNB) using liposomal bupivacaine prior to implant for postoperative pain control. Pain scores (0-10) were recorded systematically during recovery, at discharge, and at wound check follow up. Opioid use in the postoperative period was recorded as well. Results: A total of 153 patients were evaluated, 50% female with a mean age of 71.2 years. All patients received PNB successfully with no device site infection or hematoma. The mean Visualized Analog Scale (VAS) pain scores at 1, 3, and 5 hours after the procedure, at discharge, and at follow up were 1.93, 1.22, 1.10, 1.05, and 0.125 respectively. No patients required opioids for pain control throughout the average postoperative period of 14 days. Conclusion: Pectoral nerve block with liposomal bupivacaine can be administered safely before TCDI and provides adequate pain control without need for opioid use postoperatively. Further research is needed to assess broad scale implications of this approach to larger patient populations. Figure 1: Ultrasound Guided PNB, pectoralis major (PM), pectoralis minor (Pm) Graph of the average postoperative pain score and opioid use during follow up visit over time