title: Liposome bupivacaine for improvement in economic outcomes and opioid burden in GI surgery: IMPROVE Study pooled analysis.
abstract: Postsurgical pain management remains a significant challenge. Liposome bupivacaine, as part of a multimodal analgesic regimen, has been shown to significantly reduce postsurgical opioid consumption, hospital length of stay (LOS), and hospitalization costs in gastrointestinal (GI) surgery, compared with intravenous (IV) opioid-based patient-controlled analgesia (PCA). Pooled results from open-label studies comparing a liposome bupivacaine-based multimodal analgesic regimen with IV opioid PCA were analyzed. Patients (n=191) who underwent planned surgery and received study drug (IV opioid PCA, n=105; multimodal analgesia, n=86) were included. Liposome bupivacaine-based multimodal analgesia compared with IV opioid PCA significantly reduced mean (standard deviation [SD]) postsurgical opioid consumption (38 [55] mg versus [vs] 96 [85] mg; P<0.0001), postsurgical LOS (median 2.9 vs 4.3 days; P<0.0001), and mean hospitalization costs (US$8,271 vs US$10,726; P=0.0109). The multimodal analgesia group reported significantly fewer patients with opioid-related adverse events (AEs) than the IV opioid PCA group (P=0.0027); there were no significant between-group differences in patient satisfaction scores at 30 days. A liposome bupivacaine-based multimodal analgesic regimen was associated with significantly less opioid consumption, opioid-related AEs, and better health economic outcomes compared with an IV opioid PCA-based regimen in patients undergoing GI surgery.
  
  
  BACKGROUND
  This pooled analysis is based on data from Phase IV clinical trials registered on the US National Institutes of Health www.ClinicalTrials.gov database under study identifiers NCT01460485, NCT01507220, NCT01507233, NCT01509638, NCT01509807, NCT01509820, NCT01461122, NCT01461135, NCT01534988, and NCT01507246.
authors.affiliation: Atlanta Colon and Rectal Surgery, PA, Atlanta, GA, USA.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Cohen
authors.affiliation: General Surgery Clinic, University of Colorado, Aurora, CO, USA.
authors.forename: Jon D
authors.initials: JD
authors.lastname: Vogel
authors.affiliation: Department of Surgery, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
authors.forename: Jorge E
authors.initials: JE
authors.lastname: Marcet
authors.affiliation: Department of Anesthesiology, University of Miami Leonard Miller School of Medicine, Miami, FL, USA.
authors.forename: Keith A
authors.initials: KA
authors.lastname: Candiotti
keywords: analgesia; bupivacaine; gastrointestinal surgery; opioid analgesics; postoperative pain