EP175 - Randomized Controlled Trial of Liposomal Bupivacaine vs. Standard Injection on Postoperative Pain After Excisional Hemorrhoidectomy

ePoster Presenter(s)

• 

  Cora Ianiro, MD

  Research Fellow
  Ochsner Medical Center
  Ochsner Medical Center
  New Orleans, LA, United States

  Disclosure information not submitted.

Senior Author(s)

• 

  Jennifer L. Paruch, MD (she/her/hers)

  Surgeon, Principal Investigator
  Ochsner Medical Center
  Ochsner Medical Center
  New Orleans, Louisiana, United States

  Disclosure information not submitted.

Author(s)

• BK

  Brian R. Kann, MD (he/him/his)

  Chair, Dept of Colon & Rectal Surgery
  Ochsner Medical Center
  New Orleans, LA, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no relevant relationships with ineligible companies.
• DK

  Danielle Kay, MD

  Disclosure information not submitted.
• MZ

  Matthew Zelhart, MD

  Vice Chair
  Ochsner Medical Center
  New Orleans, Louisiana, United States

  Disclosure information not submitted.
• 

  William C. Kethman, MD (he/him/his)

  Surgeon
  Ochsner Medical Center
  Ochsner Health
  New Orleans, LA, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no relevant relationships with ineligible companies.
• 

  W. Forrest Johnston, MD

  Program Director, Senior Staff Surgeon
  Ochsner Health
  University of Queensland
  New Orleans, LA, United States

  Disclosure information not submitted.
• CW

  Charles Whitlow, MD

  Surgeon
  Ochsner Medical Center
  New Orleans, Louisiana, United States

  Disclosure information not submitted.
• 

  Andrew Broussard, MD

  General Surgery Resident
  Ochsner Clinic Foundation
  Ochsner Clinic Foundation
  New Orleans, LA, United States

  Disclosure information not submitted.
• 

  David Vargas, MD

  Senior Staff Surgeon and Vice Chair
  Ochsner Clinic
  New Orleans, LA, US

  Disclosure information not submitted.
• SS

  Steven Schuetz, MD

  Ochsner Medical Center

  Disclosure information not submitted.
• 

  Connie C. Shao, MD, MSPH (she/her/hers)

  Resident
  Ochsner Medical Center
  Ochsner Medical Center
  New Orleans, LA, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.

Purpose/Background: Postoperative pain control after excisional hemorrhoidectomy remains a significant challenge. Previous trials have shown improvement with liposomal bupivicaine (LB); however, it is unclear whether this remains true with modern multi-modal pain strategies. This study evaluates the impact of LB on postoperative pain following excisional hemorrhoidectomy in patients receiving a multi-modal pain regimen.

Methods/Interventions: This single-institution, single-blinded randomized controlled trial compared patients receiving LB mixed with bupivacaine (experimental) and bupivacaine mixed with lidocaine with epinephrine (control). Anesthetic type, block technique, and intraoperative adjuncts were administered at the discretion of the anesthesiologist and surgeon. Multimodal pain regimen included acetaminophen, ibuprofen, gabapentin, and oxycodone or hydromorphone.

Postoperative data were collected via REDCap surveys and phone calls. The study was powered to evaluate a difference in total morphine equivalents (mEq) required within 24 hours postoperatively. Secondary outcomes included postoperative pain scores, time to first opioid use, patient satisfaction scores, and rate of narcotic prescription refills. Statistical analysis was performed using independent t-tests.

Results/Outcomes: A total of 69 patients were randomized (Table 1). There was no significant difference in total morphine equivalents between the groups at 24 hours: 16.2 mEq vs. 22.5 mEq, respectively (p = 0.28) (Figure1). Patient satisfaction scores did not differ significantly.

Subgroup analysis showed that within the control group, use of intraoperative ketorolac demonstrated improved pain scores across all measures, whereas in the experimental group, only time to first opioid use was significantly improved. Discharge with a complete multimodal pain regimen occurred in 57.1% of experimental patients and 55.8% of controls. Among these, maximum pain scores, narcotic refill prescriptions, and total refill morphine mEq were all reduced, particularly within the control group.

Conclusion/Discussion: In this randomized trial, the use of liposomal bupivacaine did not significantly reduce postoperative opioid requirements compared to standard local anesthetic following excisional hemorrhoidectomy. However, intraoperative ketorolac use and discharge with a multimodal pain regimen were associated with improved pain and reduced opioid consumption, highlighting the importance of multimodal analgesic strategies.

Table 1
Baseline and Intraoperative Characteristics
Figure 1
Comparison of mean total postoperative morphine equivalents between liposomal bupivicaine and bupivicaine groups at 12 and 24 hours.