Liposomal Bupivacaine (Exparel) For Postoperative Pain Control Following Robotic Hysterectomy

INTRODUCTION: Adequate postsurgical pain control is linked to better patient outcomes and reduced costs. This study seeks to determine if local infiltration of liposomal bupivacaine at the time of laparoscopic port site closure significantly improves postoperative pain control and reduces narcotic requirements following robotic hysterectomy. METHODS: All women undergoing robotic hysterectomy for uterine cancer were included (N=104) in this retrospective cohort study. Patients who received a single dose of liposomal bupivacaine by local infiltration at the surgical site comprised the experimental group (N=22). Our primary outcomes were patient-reported postsurgical pain scores and inpatient narcotic consumption between women who received liposomal bupivacaine and those who did not. Secondary outcomes included hospital length of stay (LOS) and narcotic prescriptions filled within 30 days postoperatively. RESULTS: In total, 104 patients were included in the final analysis. The study and control groups were similar in terms of age, BMI, smoking status, diagnosis of chronic pain syndrome(s), preoperative narcotic use, number of lymph nodes removed, and estimated blood loss. We found no difference in postsurgical pain scores, inpatient narcotic consumption, or outpatient narcotic prescriptions filled after discharge. There was a statistically significant difference in hospital LOS, with patients in the liposomal bupivacaine group being discharged 2.4 hours earlier on average (P=.025). CONCLUSION: There is insufficient data to conclude that local infiltration of liposomal bupivacaine meaningfully improves postsurgical pain control. While the establishment of institutional protocols for multimodal postsurgical pain management to reduce opioid utilization and its attendant side effects is a worthwhile goal, further research is needed.