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Candiotti KA, Sands LR, Lee E, et al. Liposome Bupivacaine for Postsurgical Analgesia in Adult Patients Undergoing Laparoscopic Colectomy: Results from Prospective Phase IV Sequential Cohort Studies Assessing Health Economic Outcomes. Curr Ther Res Clin Exp. 2013;76:1-6doi: 10.1016/j.curtheres.2013.12.001.
Candiotti, K. A., Sands, L. R., Lee, E., Bergese, S. D., Harzman, A. E., Marcet, J., Kumar, A. S., & Haas, E. (2014). Liposome Bupivacaine for Postsurgical Analgesia in Adult Patients Undergoing Laparoscopic Colectomy: Results from Prospective Phase IV Sequential Cohort Studies Assessing Health Economic Outcomes. Current therapeutic research, clinical and experimental, 761-6. https://doi.org/10.1016/j.curtheres.2013.12.001
Candiotti, Keith A, et al. "Liposome Bupivacaine for Postsurgical Analgesia in Adult Patients Undergoing Laparoscopic Colectomy: Results from Prospective Phase IV Sequential Cohort Studies Assessing Health Economic Outcomes." Current therapeutic research, clinical and experimental vol. 76 (2014): 1-6. doi: https://doi.org/10.1016/j.curtheres.2013.12.001
Candiotti KA, Sands LR, Lee E, Bergese SD, Harzman AE, Marcet J, Kumar AS, Haas E. Liposome Bupivacaine for Postsurgical Analgesia in Adult Patients Undergoing Laparoscopic Colectomy: Results from Prospective Phase IV Sequential Cohort Studies Assessing Health Economic Outcomes. Curr Ther Res Clin Exp. 2013 Dec 27;76:1-6. doi: 10.1016/j.curtheres.2013.12.001. eCollection 2014 Dec. PMID: 25031661; PMCID: PMC3994919.
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Curr Ther Res Clin Exp. 2013 Dec 27;76:1-6. doi: 10.1016/j.curtheres.2013.12.001. eCollection 2014 Dec.

Liposome Bupivacaine for Postsurgical Analgesia in Adult Patients Undergoing Laparoscopic Colectomy: Results from Prospective Phase IV Sequential Cohort Studies Assessing Health Economic Outcomes.

Current therapeutic research, clinical and experimental

Keith A Candiotti, Laurence R Sands, Edward Lee, Sergio D Bergese, Alan E Harzman, Jorge Marcet, Anjali S Kumar, Eric Haas

Affiliations

  1. Department of Anesthesiology, University of Miami Leonard Miller School of Medicine, Miami, Florida.
  2. Department of Surgery, University of Miami School of Medicine, Miami, Florida.
  3. Department of Surgery, Albany Medical College, Albany, New York.
  4. Department of Anesthesiology and Neurological Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio.
  5. Department of Surgery, Division of Colon and Rectal Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio.
  6. Department of Surgery, Morsani College of Medicine, University of South Florida, Tampa, Florida.
  7. Department of Surgery, Section of Colon and Rectal Surgery, MedStar Washington Hospital Center, Washington, DC.
  8. Colorectal Surgical Associates, Ltd, LLP, Houston, Texas.

PMID: 25031661 PMCID: PMC3994919 DOI: 10.1016/j.curtheres.2013.12.001

Abstract

BACKGROUND: Opioid-based postsurgical analgesia exposes patients undergoing laparoscopic colectomy to elevated risk for gastrointestinal motility problems and other opioid-related adverse events (ORAEs). The purpose of our research was to investigate postsurgical outcomes, including opioid consumption, hospital length of stay, and ORAE risk associated with a multimodal analgesia regimen, employing a single administration of liposome bupivacaine as well as other analgesics that act by different mechanisms.

METHODS: We analyzed combined results from 6 Phase IV, prospective, single-center studies in which patients undergoing laparoscopic colectomy received opioid-based intravenous patient-controlled analgesia (PCA) or multimodal analgesia incorporating intraoperative administration of liposome bupivacaine. As-needed rescue therapy was available to all patients. Primary outcome measures were postsurgical opioid consumption, hospital length of stay, and hospitalization costs. Secondary measures included time to first rescue opioid use, patient satisfaction with analgesia (assessed using a 5-point Likert scale), and ORAEs.

RESULTS: Eighty-two patients underwent laparoscopic colectomy and did not meet intraoperative exclusion criteria (PCA n = 56; multimodal analgesia n = 26). Compared with the PCA group, the multimodal analgesia group had significantly lower mean total postsurgical opioid consumption (96 vs 32 mg, respectively; P < 0.0001) and shorter median postsurgical hospital length of stay (3.0 vs 4.0 days; P = 0.0019). Geometric mean costs were $11,234 and $13,018 in the multimodal analgesia and PCA groups, respectively (P = 0.2612). Median time to first rescue opioid use was longer in the multimodal analgesia group versus PCA group (1.1 hours vs 0.6 hours, respectively; P=0.0003). ORAEs were experienced by 41% of patients receiving intravenous opioid PCA and 8% of patients receiving multimodal analgesia (P = 0.0019). Study limitations included use of an open-label, nonrandomized design; small population size; and the inability to isolate treatment-related effects specifically attributable to liposome bupivacaine.

CONCLUSIONS: Compared with intravenous opioid PCA, a liposome bupivacaine-based multimodal analgesia regimen reduced postsurgical opioid use, hospital length of stay, and ORAEs, and may lead to improved postsurgical outcomes following laparoscopic colectomy.

Keywords: hospitalization cost; laparoscopic colectomy; length of stay; multimodal analgesia; opioid-related adverse events; surgery

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