Prabhu M, et al. - Whether or not a liposomal bupivacaine incisional block decreases postoperative pain and represents an opioid-minimizing strategy after scheduled cesarean delivery was investigated. A liposomal bupivacaine incisional block into the skin and fascia during closure after cesarean delivery resulted in postoperative pain scores in the first 48 hours postoperatively comparable to those observed with placebo.

Methods

• Researchers performed a single-blind, randomized controlled trial among opioid-naive women undergoing cesarean delivery.
• Liposomal bupivacaine or placebo was infiltrated into the fascia and skin at the surgical site, before fascial closure among these women.
• They assessed pain score with movement at 48 hours postoperatively as the primary outcome using an 11-point numeric rating scale.
• To detect a 1.5-point reduction in pain score in the intervention group, they identified the necessity for a sample size of 40 women per group.
• In this study, they summarized pain scores and opioid consumption, in oral morphine milligram equivalents, at 48 hours postoperatively as medians (interquartile range) and compared them using the Wilcoxon rank-sum test.

Results

• Researchers performed screening in 249 women between March and September 2017; of these, 103 women enrolled, and 80 women were randomized.
• They excluded 1 woman in the liposomal bupivacaine group after randomization as a result of a vertical skin incision, leaving 39 patients in the liposomal bupivacaine group and 40 in the placebo group.
• The groups were similar in terms of baseline characteristics.
• At 48 hours postoperatively, the median (interquartile range) pain score with movement in the liposomal bupivacaine group was 4 (2–5) and in the placebo group (P=.72) was 3.5 (2–5.5) .
• During the first 48 hours postoperatively, they noted a median (interquartile range) opioid use of 37.5 (7.5–60) morphine milligram equivalents in the liposomal bupivacaine group and 37.5 (15–75) morphine milligram equivalents in the placebo group (P=.44).