Comparing intraoperative administration of long-acting bupivacaine, multimodal cocktails, and local anesthetics for postoperative pain management

Background

Liposomal bupivacaine (LB) has gained popularity for its reported analgesic effects lasting up to 72 hours. However, multimodal local anesthetic cocktails (MCs) may offer comparable pain control with potential cost savings and opioid-sparing benefits.

Objectives

This study compared postoperative pain outcomes with LB versus MCs such as ropivacaine-epinephrine-clonidine-ketorolac, bupivacaine-epinephrine-dexamethasone, bupivacaine-meloxicam, and traditional local anesthetics (LAs) such as lidocaine and bupivacaine.

Setting and participants

This retrospective, observational study included patients who underwent outpatient and inpatient procedures between August 1, 2023, and January 31, 2024.

Outcome measures

The primary outcome was postoperative day (POD) 2 pain scores. Secondary outcomes included total morphine milliequivalents (MMEs) administered within 72 hours and projected cost savings. Participants were excluded if they were younger than 18 years, lacked documented pain scores or MME data, had a history of chronic pain, or were pregnant.

Results

Of 27,878 patients, 265 were evaluated, and 174 met the inclusion criteria. Fifty-one received LB, 73 received MCs, and 50 received LAs. POD 2 pain scores for the LB, MC, and LA groups were not statistically different (P = 0.41), with averages of 4.69, 5.05, and 4.42, respectively. Total MMEs were also similar across groups, with a median total of 48.53, 51.16, and 40.10 for LB, MCs, and LAs, respectively (P = 0.58). Our cost analysis projected annualized savings of approximately $2.8 million and average patient savings of $46,500 per surgical procedure.

Conclusion

These findings suggest that MCs are a cost-effective alternative to LB with comparable analgesic effects.