title: Wound Infiltration With Extended-Release Versus Short-Acting Bupivacaine Before Laparoscopic Hysterectomy: A Randomized Controlled Trial.
abstract: To evaluate if preincision infiltration with extended-release liposomal bupivacaine provides improved overall pain relief compared with 0.25% bupivacaine after laparoscopic or robotic-assisted hysterectomy.
  
  
  
  A single-center double-masked randomized controlled trial (Canadian Task Force Classification I).
  
  
  
  A tertiary-care community hospital.
  
  
  
  Patients recruited from July 2015 through January 2016. Sixty-four patients were randomized, and 59 were analyzed for the primary outcome.
  
  
  
  Women scheduled to undergo multiport laparoscopic or robotic-assisted total hysterectomy for benign indications were randomized to receive preincision infiltration with undiluted liposomal bupivacaine or 0.25% bupivacaine.
  
  
  
  The primary outcome was overall average pain intensity by numeric rating scale (0-10) using the Brief Pain Inventory (BPI) via telephone survey on postoperative day (POD) 3. A sample size of 28 per group (N = 56) was planned to detect a 30% change in pain scores. Secondary outcomes were overall average and worst numeric pain scores on PODs 1, 2, and 14; pain scores in hospital; BPI pain interference scores; and total opioid use. There were no demographic differences between the 2 groups. For the primary outcome, we found a decrease in the average (p = .02) pain scores on POD 3 in the liposomal bupivacaine group. We also found a decrease in worst pain scores on POD 2 (p = .03) and POD 3 (p = .01). There were no differences in pain scores while in the hospital or on POD 1 or POD 14. There were no differences in BPI pain interference scores, opioid use, or reported adverse effects.
  
  
  
  For laparoscopic and robotic-assisted multiport hysterectomies, there is evidence of decreased average postoperative pain with liposomal bupivacaine compared with 0.25% bupivacaine for port-site analgesia on POD 3, but no difference in opioid use or measures of functioning.
authors.affiliation: Division of Advanced and Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, University of Virginia School of Medicine, Charlottesville, Virgnia. Electronic address: kenneth.barron.md@gmail.com.
authors.forename: Kenneth I
authors.initials: KI
authors.lastname: Barron
authors.affiliation: Department of Obstetrics and Gynecology, University of Central Florida College of Medicine, Orlando, Florida; Division of Surgery, Gynecology Section, Orlando Veterans Affairs Medical Center, Orlando, Florida.
authors.forename: Georgine M
authors.initials: GM
authors.lastname: Lamvu
authors.affiliation: Department of Obstetrics and Gynecology, Florida Hospital Graduate Medical Education, Florida Hospital Orlando, Orlando, Florida; Department of Obstetrics and Gynecology, University of Central Florida College of Medicine, Orlando, Florida.
authors.forename: R Cole
authors.initials: RC
authors.lastname: Schmidt
authors.affiliation: Department of Obstetrics and Gynecology, Florida Hospital Graduate Medical Education, Florida Hospital Orlando, Orlando, Florida; Department of Obstetrics and Gynecology, University of Central Florida College of Medicine, Orlando, Florida.
authors.forename: Matthew
authors.initials: M
authors.lastname: Fisk
authors.affiliation: Department of Obstetrics and Gynecology, Florida Hospital Graduate Medical Education, Florida Hospital Orlando, Orlando, Florida; Department of Obstetrics and Gynecology, University of Central Florida College of Medicine, Orlando, Florida.
authors.forename: Emily
authors.initials: E
authors.lastname: Blanton
authors.affiliation: Department of Obstetrics and Gynecology, Florida Hospital Graduate Medical Education, Florida Hospital Orlando, Orlando, Florida; Department of Obstetrics and Gynecology, University of Central Florida College of Medicine, Orlando, Florida.
authors.forename: Insiyyah
authors.initials: I
authors.lastname: Patanwala
mesh_terms: D000328:Adult; D000368:Aged; D000772:Anesthesia, Local / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000494:pharmacology; D002045:Bupivacaine / Q000008:administration & dosage / Q000494:pharmacology; D003692:Delayed-Action Preparations / Q000008:administration & dosage / Q000494:pharmacology; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000379:methods; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D008081:Liposomes; D008875:Middle Aged; D059408:Pain Management / Q000379:methods; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D003692:Delayed-Action Preparations; D008081:Liposomes; D002045:Bupivacaine
keywords: Hysterectomy; Laparoscopy; Local anesthesia; Postoperative pain; Robotics