Liposomal bupivacaine infiltration into the transversus abdominis plane for postsurgical analgesia in open abdominal umbilical hernia repair: results from a cohort of 13 patients

Abstract

Background: Achieving adequate control of postsurgical pain remains a challenge in patients undergoing abdominal surgery. Transversus abdominis plane (TAP) infiltration has been shown to provide postsurgical analgesia following lower abdominal surgery. We assessed the safety and efficacy of a prolonged-release liposomal formulation of the local anesthetic bupivacaine administered via infiltration into the TAP in a cohort of patients undergoing open abdominal umbilical hernia repair.

Methods: Patients included in the study were 18-75 years of age, had American Society of Anesthesiologists physical classification status 1-3, and underwent open abdominal umbilical hernia repair with ultrasound-guided TAP infiltration immediately after surgery using an equal-volume bilateral infusion of liposomal bupivacaine 266 mg (diluted to 30 mL in normal saline). Outcome measures included patient-reported pain intensity (11-point numeric rating scale), satisfaction with postsurgical analgesia (5-point Likert scale), incidence of opioid-related adverse events, and time to first use of supplemental rescue analgesia.

Results: Thirteen patients underwent surgery and received bilateral TAP infiltration with liposomal bupivacaine; TAP infiltration failed in the first patient. Mean numeric rating scale pain scores were 0.6 immediately before TAP infiltration and remained ≤2.3 through 120 hours after infiltration; mean scores at 120 hours and 10 days were 0.9 and 0.4, respectively. Ten patients (77%) required supplemental analgesia; median time to first use was 11 hours. At discharge and day 10, 54% and 62% of patients, respectively, were "extremely satisfied" with postsurgical analgesia (Likert score 5). There were no opioid-related or other adverse events.

Conclusion: Although the current study was limited by both its lack of a control group and its small size, to our knowledge, it is the first published report on use of liposomal bupivacaine for TAP infiltration. In this cohort, liposomal bupivacaine was observed to be well tolerated with encouraging analgesic efficacy.

Keywords: analgesia; bupivacaine; hernia repair surgery; infiltration anesthesia; postoperative pain.

Figures

Figure 1

Mean patient-reported postsurgical pain intensity scores based on the NRS (0= no pain, 10= worst possible pain) following open abdominal umbilical hernia repair (n=13 for 8-hour and 24-hour time points; n=12 for all other postsurgical time points). Error bars represent SD. Abbreviations: NRS, numeric rating scale; SD, standard deviation.

Figure 2

Time to first postsurgical use of supplemental analgesia for ten patients who requested rescue analgesia. Three patients (of 13) did not require supplemental analgesia.

Figure 3

Patient-reported satisfaction (n=13) with postsurgical analgesia, from responses on a 5-point Likert scale where “extremely satisfied” =5; “satisfied” =4; “neutral” =3. For each time point, response from one patient was not obtained.