Earlier liposomal bupivacaine blocks improve analgesia and decrease opioid requirements for bariatric surgery patients

Abstract

Introduction: Optimal timing of liposomal bupivacaine (LB) transversus abdominis plane (TAP) blocks for bariatric surgery is unknown. We hypothesize that LB TAPs used prior to incision decrease narcotic requirements compared to the completion of surgery.

Methods: Single intuition review of 86 bariatric surgery patients who received LB TAP blocks from 2/2019 through 8/2020. 44 patients received LB at the beginning of the case (Beg) while 42 patients received LB at the completion (End). Morphine equivalent daily doses (MEDD) were compared.

Results: MEDD requirements for the Beg-LB group compared to the End-LB group were significantly less on POD 0 (4.8 vs 6.8 MEDD, p = 0.01) and POD 2 (16 vs 32, p = 0.04). Discharge oxycodone prescriptions were lower in the Beg-LB group (15 vs 20, p = 0.008).

Conclusions: Patients who received LB TAP blocks prior to bariatric surgery required fewer narcotics than patients who received the LB TAP at the conclusion of surgery.

Keywords: Bariatric surgery; Gastric bypass; Liposomal bupivacaine; Post-operative pain; Transversus abdominis plane blocks.