Long-Acting Bupivacaine for Pain Control After Cesarean Birth

Abstract

Objective: To evaluate women's postcesarean pain levels and total opioid use for standard opioid pain management compared with local anesthetic with patient-requested opioids.

Design: Retrospective cohort study.

Setting/local problem: Rural southeast Ohio. Ohio had a higher rate of opioid use disorder (1.4%) than both the regional average (0.8%) and the national average (0.7%).

Participants: We performed a retrospective study of 402 medical records of women who gave birth by cesarean.

Intervention: Women were provided one of three types of perioperative anesthesia: routine spinal (standard of care group), wound infiltration with liposomal bupivacaine (LB INF), and transversus abdominis plane (TAP) block with liposomal bupivacaine (LB TAP). Data were collected on the amount of opioids taken postoperatively (measured as morphine milligram equivalents [MME]), pain scores, and history of opioid use.

Results: The LB INF and LB TAP groups had significantly lower total and average MME per day than the standard of care group (p < .001). Pain scores for the LB INF group were lower on postoperative day (POD) 0 and POD1, whereas LB TAP pain scores were lower than standard of care pain scores on POD1 (p < .004). Women with a prior history of substance use disorders reported higher pain scores, took more total opioids. and stayed in the hospital longer regardless of type of anesthesia received (p < .001).

Conclusion: LB INF and LB TAP were associated with lower amounts of opioids used and with lower postcesarean pain scores compared with the standard of care.

Keywords: TAP block; cesarean birth; liposomal bupivacaine; opioid; opioid reduction; pain management; substance use disorder; transversus abdominis plane block.