Liposomal Bupivacaine Reduces Opioid Consumption After Liver Resection

Originally published by our sister publication Anesthesiology News

PHILADELPHIA—Thoracic paravertebral block with liposomal bupivacaine (Exparel, Pacira BioSciences) reduces total postoperative opioid consumption relative to standard bupivacaine plus dexamethasone in patients undergoing liver resection, according to the results of a new study. However, the trial found differences between groups within a number of other end points.

“Liver resection is a very painful procedure and is typically associated with a large consumption of opioids during the first 72 hours after surgery,” said Jiangling Wang, PhD, a researcher at Zhejiang Cancer Hospital, in Hangzhou, in China. “Although many studies have proved the effectiveness of liposomal bupivacaine in multiple surgery types, none have examined its effects in liver resection with thoracic paravertebral block.” As such, she and her colleagues sought to evaluate the efficacy of liposomal bupivacaine for pain management and recovery after liver resection.

The investigators enrolled 93 patients into the prospective study (ClinicalTrials.gov Identifier: NCT06173466), all of whom were undergoing liver resection for hepatocellular carcinoma. In addition to standard care, all patients received an ultrasound-guided thoracic paravertebral block; those in the liposomal bupivacaine group received 133 mg of the study drug, while their counterparts received 150 mg of standard 0.25% bupivacaine combined with 4 mg of dexamethasone.

The study’s primary outcome was cumulative opioid consumption in the first 72 hours after surgery. Secondary end points included the time to first opioid use after surgery, plasma bupivacaine concentration, Quality of Recovery-40 (QoR-40) score at 72 hours and visual analog scale (VAS) pain score area under the curve (AUC) from six to 72 hours. The researchers also recorded adverse events and serious adverse events after the block.

Presenting at the 2024 annual meeting of the American Society of Anesthesiologists (abstract A1188), the researchers reported that cumulative opioid consumption was significantly lower in the liposomal bupivacaine group over the first 72 hours postoperatively (P=0.04). This difference was most pronounced in the first 24 hours after surgery, when liposomal bupivacaine patients consumed 18.0 mg, compared with 40.5 mg among those who received standard bupivacaine (P=0.0003). The time to first opioid use also was significantly longer in the liposomal bupivacaine group (199.0 vs. 36.0 minutes; P=0.02).

Plasma bupivacaine concentration also was found to be significantly higher in the liposomal bupivacaine group at 24 hours (310.2 vs. 213.3 ng/mL; P=0.012), 48 hours (231.2 vs. 19.5 ng/mL; P=0.0001) and 72 hours (59.6 vs. 1.9 ng/mL; P<0.0001) postoperatively. Despite these differences, the two groups proved comparable in terms of QoR-40 score at 72 hours (P=0.53) and VAS pain score AUC from six to 72 hours (P=0.40). No adverse events or serious adverse events were observed.

“Our conclusion is that thoracic paravertebral block with liposomal bupivacaine reduces postoperative opioid consumption after liver resection, while the plasma bupivacaine concentration was stable with the drug,” Wang said. “This has already changed routine practice in our department when it comes to pain management after liver cancer resection.”

By Michael Vlessides

Wang reported no relevant financial disclosures.