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Does Liposomal Bupivacaine Decrease Postoperative Opioid Use in Conjunction with an Enhanced Recovery After Bariatric Surgery Pathway? A Prospective, Double-blind, Randomized Controlled Trial

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Abstract

Background

Minimization of opiate use is an important focus in the setting of the severe national opioid crisis. This study evaluated the role of liposomal bupivacaine (LB) in decreasing postoperative opioid use before and after implementation of a bariatric enhanced recovery after surgery (ERAS) program.

Methods

We performed an IRB-approved, prospective, double-blind, randomized controlled trial of LB versus plain bupivacaine (PB) in patients undergoing elective, minimally invasive, weight loss surgery at a comprehensive metabolic and bariatric surgery program from November 2017 to December 2019. Primary outcomes were postoperative morphine milligram equivalents per day (MME/day) and average subjective inpatient pain level. Secondary outcomes were length of hospital stay (LOS) and adverse events (AEs).

Results

Of the 100 patients enrolled, 78 were randomly assigned to LB (42) or PB (36). Thirty-four received the ERAS protocol, and 44 did not. The mean MME/day use did not differ significantly by the bupivacaine group [median, IQR PB: 20.3 (40.95); LB: 33.0 (42.9); p = .314], but it did differ by the ERAS group [median, IQR no ERAS 33.2 (47.1), ERAS 24.0 (34.0); p = .049]. Length of stay, inpatient pain score, and AEs did not differ significantly by either the bupivacaine or the ERAS group.

Conclusions

In our study, liposomal bupivacaine did not significantly decrease postoperative opioid use either before implementation of ERAS or as part of an enhanced recovery after surgery program for minimally invasive bariatric surgery procedures.

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Data Availability

Data is available upon request for the methods and materials related to this project.

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Acknowledgements

The authors would like to express our appreciation for the support of the inpatient Pharmacy Department and, particularly, the persistent support provided by Pharmacist Yuet H. Lam. All individuals in acknowledgements have given written permission to be named.

Author information

Authors and Affiliations

  1. General Surgery Department, Navy Medicine Readiness & Training Command, 34800 Bob Wilson Drive, San Diego, CA, 92134, USA

    Elise Becker, Amy Hernandez, Kyle Gadbois, David Gallus & Gordon Wisbach

  2. Clinical Investigation Department, Navy Medicine Readiness & Training Command, San Diego, CA, 92134, USA

    Howard Greene

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  2. Amy Hernandez
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Contributions

All authors have contributed equally to this work.

Corresponding author

Correspondence to Gordon Wisbach.

Ethics declarations

Ethical Approval

All procedures performed in this study that involved human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent Statement

Informed consent was obtained from all individual participants included in this study.

Conflict of Interest

The authors declare no competing interests.

Disclaimer

The views expressed in this article reflect the results of research conducted by the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the United States Government.

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Copyright Statement

Military services members are authors of this work that was prepared as part of official duties. Title 17 U.S.C 105 provides that “copyright protection under this title is not available for any work of the United States Government.” Title 17 U.S.C 230 101 defines a US Government work as work prepared by a military service member or employee of the US Government as part of that person’s official duties.

Recognition

• Poster presentation of early data during Obesity Week 2019.

• Poster presentation of complete data during ASMBS conference 2021.

• Podium presentation at the Navy Medicine Readiness & Training Command, San Diego regional Academic Research Competition 2021—Awarded: 1st place in Resident Category.

• Podium presentation at the US Navy-wide research competition 2021—Awarded: finalist.

Key Points

• The opioid crisis demands multimodal pain management of postoperative patients.

• Enhanced recovery after bariatric surgery protocols are widely adopted.

• Long-acting bupivacaine use in the setting of an ERAS has minimal benefit.

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Becker, E., Hernandez, A., Greene, H. et al. Does Liposomal Bupivacaine Decrease Postoperative Opioid Use in Conjunction with an Enhanced Recovery After Bariatric Surgery Pathway? A Prospective, Double-blind, Randomized Controlled Trial. OBES SURG 33, 555–561 (2023). https://doi.org/10.1007/s11695-022-06417-x

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