Anesthesia & Pain Research


Is There A Role for Liposomal Bupivacaine as Part of a Multimodal Strategy Inclusive of Intrathecal Morphine for Post-Cesarean Analgesia? A Retrospective Chart Review Study

Antonio Gonzalez Fiol MD, Anna-Maria Eid MD, Mohamed Yassin Elgamal MD, Hollie Matlin MD, Kristen L. Fardelmann, MD, David Yanez, PhD, MS, Angelique Garay, DNAP, CRNA II, ACNP, Aymen Alian MD

Background: The search for the ideal postoperative analgesia is crucial given the current opioid epidemic in the United States. Liposomal bupivacaine for transverse abdominis plane block, inclusive of intrathecal morphine may improve analgesia for more than 24 h. We assessed opioid consumption after cesarean delivery and the time to first narcotic.

Methods: We conducted a single-center retrospective chart review of cesarean deliveries. All patients received a spinal anesthetic with 100 mcg of intrathecal morphine and postoperative multimodal analgesia. A total of 82 patients received the transverse abdominis plane block while 140 patients did not. We tested the adjusted hazards using Cox regression, adjusting for BMI and number of cesarean delivery.

Results: The estimated mean time to first opioid request in the block versus no block group was ~30 hours and 15 hours respectively (p=0.002). A Cox regression analysis comparing the two groups, estimated the risk of receiving a first narcotic in the block group to be one-half of those who did not receive a transverse abdominis plane block
(HR = 0.48, 95% CI = [0.36, 0.65], p< 0.001).

Conclusion: Our study demonstrated that patients who received transverse abdominis plane block had less opioid use in the first 72 hours with a mean opioid-sparing time of 30 hours, twice the time of the other group. This may be explained by the use of liposomal bupivacaine in our blocks which confers a prolonged bupivacaine release and may play a role in longer narcotic free intervals and decreased total postoperative narcotic consumption.

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