Background

Use of liposomal bupivacaine (Exparel®) in surgery is reported with decreased postoperative opioid requirements. The efficacy of liposomal bupivacaine versus standard bupivacaine injections at laparoscopic port sites during bariatric surgery is unknown.

Methods

To determine whether there was difference in post-operative hospital opioid requirements after port site injections of liposomal bupivacaine versus standard bupivacaine during laparoscopic bariatric surgeries. Opioid use converted to morphine equivalent units (MEU) with secondary end points including home opioid use, pain scores, length of stay and adverse events. Setting: Academic-affiliated private practice. 2-group randomized, double blinded trial from November 2017- August 2018 with patients randomly assigned to receive either liposomal bupivacaine(LB) or bupivacaine alone at trocar site injections during laparoscopic roux-en-Y gastric bypass (RYGB) or vertical sleeve gastrectomy (VSG).

Results

179 of 231 patients (77%) completed the trial, randomized into LB (n= 89) and bupivacaine alone (n=90) groups. There was no significant difference in postoperative MEU as described in Table 2. There were more patients in the bupivacaine group that did not take pain medications on postoperative day 2-4 (p<0.05).

Conclusions

Among patients undergoing primary bariatric surgery under ERABS protocol, there was no significant difference in postoperative hospital opioid use in those receiving liposomal bupivacaine compared to standard bupivacaine. A greater percentage of patients in the standard bupivacaine group did not require any narcotics at home. In order to minimize opioid use after bariatric surgery, resources should focus on multimodal approaches instead of reliance on anesthetic medication used.