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Impact of Liposomal Bupivacaine on Postoperative Opioid Consumption in Thoracic Surgery
Thursday April 24, 2025 4:40pm - 4:55pm EDT
Olympia 1
Ttile: Impact of Liposomal Bupivacaine on Postoperative Opioid Consumption in Thoracic Surgery


Authors: Stefanie Pappas, Jordan Brooke Bibb, John Lazaar


Introduction: With advancements in multimodal and regional anesthesia, non-opioid pain management strategies have become increasingly popular. Local anesthetics can play a key role in minimizing opioid use and related complications; however, their effectiveness is often limited by a short duration of action. At Ascension Saint Thomas Hospital West (ASTHW), elastomeric infusion pumps were commonly utilized in thoracic surgery patients to deliver plain bupivacaine at the surgical site via an indwelling catheter. In June 2022, liposomal bupivacaine, a long acting formulation, was added to hospital formulary and replaced the use of infusion pumps. Research on liposomal bupivacaine has shown benefits such as reduced opioid use, lower pain scores, and shorter hospital stays, although results vary based on surgical site, technique, and intervention. The purpose of this study was to determine the impact on inpatient opioid consumption in thoracic surgery patients when utilizing a liposomal bupivacaine block compared to local infiltration of plain bupivacaine via an elastomeric infusion pump. 


Methods: This is a single-center, retrospective chart review of patients who underwent robotic lobectomy at ASTHW during two time periods: June 2021 through June 2022 and August 2022 through March 2024. Patients were included if they were at least 18 years of age and received either a single administration of liposomal bupivacaine or a continuous administration of plain bupivacaine via an elastomeric infusion pump. Patients with a history of substance use disorder, concurrent use of buprenorphine, methadone, naltrexone, were pregnant, or incarcerated were excluded. The primary outcome was to determine if there was a difference in postoperative morphine milligram equivalent (MME) usage between the two cohorts. Secondary outcomes included postoperative pain scores, hospital length of stay and incidence of post-operative wound infection.


Results: Sixty-two patients were included in the study (plain bupivacaine = 34; liposomal bupivacaine = 24). There was no statistically significant difference in postoperative MME usage between the plain bupivacaine group and liposomal bupivacaine group on day 1 (36.5  vs. 41.3; p = 0.92), day 2 (15 vs. 15; p = 0.84) or day 3 (2.5  vs. 3.25 ; p = 0.91).  The groups were also similar in postoperative pain scores, hospital length of stay, and incidence of wound infection.


Conclusion: 
In our study of patients undergoing robotic lobectomy, single administration of a liposomal bupivacaine block was comparable to local infiltration of plain bupivacaine for postoperative opioid consumption. Further research is needed to confirm any potential benefit; however, it appears that liposomal bupivacaine may be a similar and less invasive alternative for our thoracic surgery patients.
Moderators
avatar for Saumil Vaghela

Saumil Vaghela

Clinical Pharmacy Manager, PGY1 RPD, CaroMont Health
Clinical pharmacy manager, EM background, RPD, adjunct faculty. Supporting those who provide patient-centered, evidence-based care and facilitating the classroom-to-bedside transition for new practitioners.
Presenters
avatar for Stefanie Pappas

Stefanie Pappas

PGY-1 Pharmacy Resident, Ascension Saint Thomas Hospital West
PGY-1 Pharmacy Resident - Ascension Saint Thomas Hospital West
Evaluators
avatar for Michael Saxon

Michael Saxon

Clinical Pharmacy Manager, Northside Hospital
I am the Clinical Manager of Pharmacy Services and outgoing PGY1 Residency Program Director at Northside Hospital Atlanta. I attended Mercer University for my pre-pharmacy courses and graduated from the University of Georgia College of Pharmacy in 2015. I completed a PGY1 Pharmacy... Read More →
Thursday April 24, 2025 4:40pm - 4:55pm EDT
Olympia 1
  Pain Management (PM), Ascension Saint Thomas Health
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