Systematic Review of Liposomal Bupivacaine in Thoracic Surgery

#AN/CAR 01-EP-2
Anaesthesia, Critical Care /Cardiac and Thoracic Surgery. E-POSTER (ORAL) SESSION
E-Poster (oral)

Systematic Review of Liposomal Bupivacaine in Thoracic Surgery

Minh D. Tran, Justin Chan, Michael Worthington

Royal Adelaide Hospital, Adelaide, Australia

Date, time and location: 2018.05.25 15:30, Exhibition area, 1st Floor. Zone – B

Abstract

Objective

Liposomal bupivacaine (LipoB) is a novel analgesic in thoracic surgery, with several advantages over current practices.

Analgesia using regional neuroaxial blockade is the standard of care for patients undergoing major thoracic surgery. Thoracic epidural analgesia (TEA) is the gold standard, however has many disadvantages, including hypotension, nausea, urinary retention, and its administration is highly operator dependent. Single-shot paravertebral blockade provides effective analgesia, but is limited by the short duration of most local anaesthetics. Prolonging paravertebral blockade requires an infusion catheter. The recent availability of LipoB presents the potential to deliver prolonged blockade of intercostal nerves (72 to 96 hours), without the disadvantages of TEA, and does not require a constant infusion.

We present a systematic review on LipoB in thoracic surgery.

Methods

A comprehensive search strategy of PubMed, Embase, Scopus and Google Scholar identified studies of liposomal bupivacaine in thoracic surgery, using the terms “liposomal OR liposome bupivacaine” and “thoracic surgery”. Studies were summarised and assessed by quality of evidence.

Results

We identified 5 relevant studies. A total of 212 patients were included. Common primary outcomes measured include: length of hospital stay, pain scores, and opioid usage. 3 studies reported reduced length of stay with LipoB. 2 studies reported lower pain scores, 2 reported no difference, while 1 reported higher pain scores.

In the early experience of LipoB, no specific adverse outcomes were described.

Conclusions

LipoB appears to be safe and effective after thoracic surgery. It has theoretical advantages of persistent effect, providing prolonged analgesia without the use of an infusion catheter, and reduced side effects compared to TEA, given its localised administration.

These properties resulted in lower cumulative pain scores, reduced opioid requirements, expedited discharge from hospital, and ultimately, reduced hospital cost.

Given these promising preliminary results, we would recommend further research before definitive recommendations can be made.