Background

Background: Excessive opioid consumption increases the risk of addiction and adverse drug events and should be limited. Liposomal bupivacaine (LB) has been associated with reduced postoperative opioid consumption in other surgery was included for perioperative multimodal pain control for patients undergoing bariatric surgery at our institution. The effect of LB on inpatient opioid consumption has not been extensively evaluated in patients who have undergone bariatric surgery. Objective: Evaluate opioid consumption in patients undergoing laparoscopic sleeve gastrectomy before and after implementation of LB as part of perioperative, multimodal pain control bundle. Setting: Academic medical center, United States

Methods

A retrospective, pre/post quasi-experimental study was conducted to identify the effect of LB in patients (n=483) who had undergone laparoscopic sleeve gastrectomy between 03/01/2017 and 06/30/2019. Intervention took place 03/07/2018, with no-LB (n=198) before and LB (n=285) after this time. Patients (n=362) were propensity score-matched (PS) 1:1 with inpatient morphine milligram equivalents (MME), ketorolac, intravenous acetaminophen, and baseline demographics compared. Multivariate linear regression was used to assess the impact of variables on opioid consumption.

Results

Compared to no-LB, LB was associated with fewer median MME in the total (100.0 vs 173.8 mg, p<0.001) and PS (100.0 vs 170.0 mg, p<0.001) populations. In the multivariate analysis, LB was associated with a 94.84mg (95% CI, -114.10 - -75.58, p<0.001).

Conclusions

Liposomal bupivacaine given in the perioperative setting was associated with a significant decrease in post-operative, inpatient opioid consumption. It is unknown if these findings extend to the consumption of opioids in the post-discharge setting.