Results presented at the Regional Anesthesiology and Acute Pain Medicine Meeting showed that patients who underwent major lower extremity amputation and received peripheral nerve blockade with combined standard and liposomal bupivacaine had lower oral morphine-equivalent use than patients who did not receive regional anesthesia.
Catalina I. Dumitrascu, MD, and colleagues categorized 631 patients undergoing major lower extremity amputation to three categories: no regional anesthesia (n=416), peripheral nerve blockade with standard bupivacaine alone (n=84) or peripheral nerve blockade with a mixture of standard and liposomal bupivacaine (n=131).
“Our primary outcome was total postoperative oral morphine-equivalent use at 72 hours,” Dumitrascu said in a press release. “Secondary outcomes included pain scores at 24, 48 and 72 hours and any pain scores greater than seven out of 10 in the first 72 hours, as well as postoperative opioid-related respiratory depression.”
In a multivariable analysis adjusted for history of chronic pain, preoperative opioid use, patient comorbidities, surgical features and baseline pain scores, results showed patients in the no regional anesthesia group had 1.5- times greater opioid requirements compared with patients who received peripheral nerve block with combined standard and liposomal bupivacaine. Dumitrascu noted that there was also signal for benefit in the group of patients receiving peripheral nerve block with standard bupivacaine alone, such that opioid consumption was 30% higher in the no regional group; though these results did not meet statistical significance.
“Importantly, there was no difference in opioid utilization between patients using regional anesthesia with or without liposomal bupivacaine,” Dumitrascu said. – by Casey Tingle
Dumitrascu CI, et al. Abstract 6562. Presented at: Regional Anesthesiology and Acute Pain Medicine Meeting; April 11-13, 2019; Las Vegas.
Disclosure: Dumitrascu reports no relevant financial disclosures.