2025 Southeastern Residency Conference

Title: Effect of Bupivacaine Liposome Injectable Suspension Administration in Abdominal Surgery


Authors: Allison Daneault, John Shadowen, Will Johnson, Elizabeth Oglesby


Objective: Define the efficacy outcomes used for bupivacaine liposome injectable suspension in the studied abdominal surgical population.


Self Assessment Question: Based on the findings of this study, which outcome was reduced in the bupivacaine liposome injectable suspension treatment group?
A. Patient reported pain scores
B. Hospital length of stay
C. Opioid usage


Background: Uncontrolled post-operative pain can lead to an increased need for analgesics and contribute to increased length of hospital stay. Bupivacaine liposome injectable suspension is an extended-release local anesthetic approved to reduce post-surgical pain for up to 72 hours. This study compared outcomes in patients that received bupivacaine liposome injectable suspension versus patients that received another local anesthetic prior to an abdominal procedure. The goal of this study was to determine if there is additional benefit associated with injectable bupivacaine liposome in decreasing opioid use as compared to other local anesthetics. 


Methods: A retrospective chart review was conducted comparing surgical patients who received bupivacaine liposome injectable suspension compared to those receiving an alternative local anesthetic. Abdominal surgical patients from April to October 2023 that received injectable bupivacaine liposome prior to the procedure were analyzed to be included in the study. Data from the comparator group were collected from April to August 2016 prior to the utilization of injectable bupivacaine liposome at Mobile Infirmary Medical Center. The primary outcome of this study was to compare the difference in mean morphine milligram equivalents (MME) administered within the first 72 hours after surgery between the two treatment groups. Secondary outcomes included length of hospital stay (LOS), pain scores (12, 24, 48, and 72 hours post-operation) on a numeric 0-10 scale, time to first post-operation bowel movement, discharge opioid prescriptions, and all cause 30-day readmission. Exclusion criteria included non-abdominal procedures, patients with less than a 24-hour hospital stay, outpatient surgeries, and patients that remained intubated for the first 72 hours post-operation.


Results: Each group contained 75 patients amounting to a total of 150 patients in the study sample.  65% of the abdominal surgeries in the injectable bupivacaine liposome group were colectomies compared to 77% of procedures using an alternative anesthetic. 93% of the injectable bupivacaine liposome group underwent robotic surgeries versus 58% of the control group. There was no significant difference in the primary outcome of mean number of MME between the two groups (injectable bupivacaine liposome 69.91 ± 55.26 vs control 74.47 ± 59.01, p = 0.618). There was, however, a significant difference found between the average LOS in the injectable bupivacaine liposome group compared to control (111.23 hours ± 67.01 versus 212.52 hours ± 171.21, p < 0.0001), which equates to approximately double the LOS for the patients prior to injectable bupivacaine liposome use at Mobile Infirmary. Subgroup analysis of LOS of robotic and laparoscopic procedures also showed a significantly shorter LOS for patients receiving injectable bupivacaine liposome (105.76 hours ± 57 (n = 70) versus 180.77 hours ± 164.44 (n = 42), p = 0.0007).    


Conclusion: Bupivacaine liposome injectable suspension did not exhibit a significant difference in MME utilization in the patients reviewed in this study. However, there was a statistically significant shorter length of hospital stay. A limitation of this study was that the comparator sample was from before injectable bupivacaine liposome was used at Mobile Infirmary, leading to an 8-year gap between the patient groups. In this timeframe, surgical techniques have advanced, and the hospital has instituted enhanced recovery protocols that this study was not able to account for. Further research is needed to account for these variables.