title: Liposome Bupivacaine for Postsurgical Analgesia in Adult Patients Undergoing Laparoscopic Colectomy: Results from Prospective Phase IV Sequential Cohort Studies Assessing Health Economic Outcomes.
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.
authors.affiliation: Department of Anesthesiology, University of Miami Leonard Miller School of Medicine, Miami, Florida.
authors.forename: Keith A
authors.initials: KA
authors.lastname: Candiotti
authors.affiliation: Department of Surgery, University of Miami School of Medicine, Miami, Florida.
authors.forename: Laurence R
authors.initials: LR
authors.lastname: Sands
authors.affiliation: Department of Surgery, Albany Medical College, Albany, New York.
authors.forename: Edward
authors.initials: E
authors.lastname: Lee
authors.affiliation: Department of Anesthesiology and Neurological Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio.
authors.forename: Sergio D
authors.initials: SD
authors.lastname: Bergese
authors.affiliation: Department of Surgery, Division of Colon and Rectal Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio.
authors.forename: Alan E
authors.initials: AE
authors.lastname: Harzman
authors.affiliation: Department of Surgery, Morsani College of Medicine, University of South Florida, Tampa, Florida.
authors.forename: Jorge
authors.initials: J
authors.lastname: Marcet
authors.affiliation: Department of Surgery, Section of Colon and Rectal Surgery, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Anjali S
authors.initials: AS
authors.lastname: Kumar
authors.affiliation: Colorectal Surgical Associates, Ltd, LLP, Houston, Texas.
authors.forename: Eric
authors.initials: E
authors.lastname: Haas
keywords: hospitalization cost; laparoscopic colectomy; length of stay; multimodal analgesia; opioid-related adverse events; surgery