title: A Randomized Controlled Trial for Pain Control in Laparoscopic Urologic Surgery: 0.25% Bupivacaine Versus Long-Acting Liposomal Bupivacaine.
abstract: OBJECTIVE
  Liposomal bupivacaine is a delayed-release preparation providing up to 72 hours of local analgesia. It costs much more than standard bupivacaine, however. A prospective, randomized, patient-blinded, controlled trial was performed to assess the efficacy of liposomal bupivacaine versus 0.25% bupivacaine when injected into surgical incisions during laparoscopic and robot-assisted urologic surgery.
  
  
  METHODS
  A total of 206 adults were randomized to receive liposomal bupivacaine or 0.25% bupivacaine. All surgical incisions were injected with liposomal bupivacaine or 0.25% bupivacaine with systematic dosing. The primary outcome was total opioid consumption during the postoperative hospital stay. All opioid doses were converted to morphine equivalents. Secondary end points included pain scores using visual analog pain scales, duration of hospital stay, and the time to first opioid use. A subgroup analysis was performed for renal surgery patients.
  
  
  RESULTS
  There was no significant difference in median total opioid use during the hospital stay between those who received liposomal bupivacaine (15 [interquartile range (IQR) 6.7-27] mg) and 0.25% bupivacaine (17.3 [IQR 8.3-30.5] mg) (P=0.39). Furthermore, pain scores, length of hospital stay, and time to first opioid use did not differ between groups. Subgroup analysis of laparoscopic renal surgery revealed no difference between liposomal bupivacaine and 0.25% bupivacaine.
  
  
  CONCLUSIONS
  For laparoscopic and robot-assisted urologic surgery, there is no significant difference between liposomal bupivacaine and 0.25% bupivacaine for local analgesia at the incision sites.
authors.affiliation: 1 Department of Urology, 48th MDG, RAF Lakenheath , Brandon, Suffolk, United Kingdom .
authors.forename: Richard B
authors.initials: RB
authors.lastname: Knight
authors.affiliation: 2 Louisiana Urology , LLC, Baton Rouge, Louisiana.
authors.forename: Paul W
authors.initials: PW
authors.lastname: Walker
authors.affiliation: 3 Department of Urology, San Antonio Military Medical Center , Fort Sam Houston, Texas.
authors.forename: Kirk A
authors.initials: KA
authors.lastname: Keegan
authors.affiliation: 4 University of Texas Health Science Center at San Antonio , San Antonio, Texas.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Overholser
authors.affiliation: 3 Department of Urology, San Antonio Military Medical Center , Fort Sam Houston, Texas.
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Baumgartner
authors.affiliation: 3 Department of Urology, San Antonio Military Medical Center , Fort Sam Houston, Texas.
authors.forename: James S
authors.initials: JS
authors.lastname: Ebertowski
authors.affiliation: 3 Department of Urology, San Antonio Military Medical Center , Fort Sam Houston, Texas.
authors.forename: James K
authors.initials: JK
authors.lastname: Aden
authors.affiliation: 5 Urology San Antonio , San Antonio, Texas.
authors.forename: Michael A
authors.initials: MA
authors.lastname: White
mesh_terms: D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008081:Liposomes / Q000737:chemistry*; D008297:Male; D008875:Middle Aged; D059408:Pain Management; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy; D011446:Prospective Studies; D065287:Robotic Surgical Procedures; D025321:Surgery, Computer-Assisted; D013520:Urologic Surgical Procedures / Q000379:methods*
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D008081:Liposomes; D002045:Bupivacaine