NARUS 2018: Effect of Bupivacaine Liposome Injectable Solution on Pain Control and Outcomes following Robotic-Assisted Laparoscopic Prostatectomy
Background
Bupivacaine liposome injectable solution (BLIS), or Exparel®, is a local anesthetic advertised to provide pain relief for 2-3 days once injected into the surgical incision. The authors aimed to compare BLIS to 0.25% bupivacaine (RB) to determine if any significant differences existed in regards to pain control, pain medication use, and length of hospital stay after robotic-assisted laparoscopic radical prostatectomies (RALRPs).
Methods
Since July 2015, the authors conducted a randomized, controlled, single-blinded, single-surgeon, prospective study to assess pain control with BLIS. Patients were randomized to either a control group receiving RB or an interventional group receiving BLIS. The main study outcomes were changes in patients’ pain levels, the amount of opioid pain medications used, and length of hospital stay.
Results
A total of 33 patients were enrolled in the study. No statistically significant difference between those that received BLIS and those who received RB was noted. Total IV opioid equivalents showed that BLIS used 2.0mg (+3.3) vs RB which used 2.1mg (+4.0) (p value=0.9349). The total oral opioid equivalents showed that BLIS took only 3.5mg (+4.7) vs RB patients who took 6.3mg (+5.0) (p value=0.0852). Although no statistical significance was noted, oral opioid intake trended towards significance. Total morphine equivalents were 5.5mg in the BLIS group versus 8.5mg in the RB group (p=0.3028). Additionally, length of stay was 25.5 hours versus 31.1 hours (p=0.1884). Finally, length of hospital stay trended towards significant improvement, but ultimately no significant difference was found.
Conclusions
Based on this small study, BLIS does not provide significant improvement of pain control or medication use after RALRP. Further research and evaluation would need to be completed to confirm these findings.
Presented By: Alex Katich, Charleston Area Medical Center, USA
Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, @GoldbergHanan, at the 2018 North American Robotic Urology Symposium, February 16-17, 2018 - Las Vegas, NV