Standard Local Anesthetic Bupivacaine Vs Liposomal Bupivacai
The results of this newer JAMA study do not support the superior performance of liposomal bupivacaine compared with bupivacaine for postoperative pain control in cardiothoracic and vascular truncal incisions.

Liposomal bupivacaine for pain relief is purported to last 3 days compared with 8 hours with standard bupivacaine. This study was aimed to compare the effectiveness of single-administration standard bupivacaine vs liposomal bupivacaine in patients undergoing truncal incisions.

This randomized clinical trial enrolled patients undergoing sternotomy, thoracotomy, mini-thoracotomy, and laparotomy from a single cardiovascular surgery department. The study was powered to detect a Cohen effect size of 0.35 with a power of greater than 80%.

A total of 280 patients were analyzed, with 140 in each group.

--Irrespective of treatment assignment, pain decreased by a mean of approximately 1 point per day over 3 days.

--Incision type was associated with pain with patients undergoing thoracotomy (including mini-thoracotomy) reporting the highest median pain scores on postoperative days 1 and 2 but not day 3, irrespective of the treatment group.

--The median 3-day cumulative NRS was 12.0 for bupivacaine and 13.5 for liposomal bupivacaine.

--Furthermore, the use of opioids was greater following liposomal bupivacaine compared with standard bupivacaine.

--On multivariable analysis, no interaction by incision type was observed for mean pain scores or opioid use.

In this randomized clinical trial involving truncal incisions for cardiovascular procedures, liposomal bupivacaine did not provide improved pain control and did not reduce adjunctive opioid use compared with conventional bupivacaine formulation over 3 postoperative days.