AAPS Conference Coverage

Liposomal Bupivacaine and Pain Control in Breast Reconstruction

Miranda Manier, BA

Key Highlights

  • Liposomal bupivacaine did not reduce postoperative pain scores, opioid use, or hospital length of stay.
  • Patients who received liposomal bupivacaine had higher postoperative opioid consumption.
  • The use of liposomal bupivacaine was not associated with improved recovery outcomes in breast reconstruction.
  • Higher cost of liposomal bupivacaine may not be justified given the lack of clinical benefit.

In a cross-sectional analysis presented at the 103rd American Association of Plastic Surgeons Annual Meeting, researchers found that liposomal bupivacaine did not confer improved outcomes in postoperative pain control, opioid use, or length of stay for patients undergoing immediate tissue expander-based breast reconstruction. Despite its rising popularity and significant cost, the anesthetic showed no benefit over standard methods in the perioperative setting. Multivariate regression analysis associated its use with increased opioid consumption.

The study was prompted by the increasing adoption of liposomal bupivacaine for interfascial pectoralis blocks during breast reconstruction. Although the agent is marketed as a long-acting alternative for pain control, evidence supporting its superiority has been limited. This investigation sought to provide clarity on its actual clinical effectiveness in a practical surgical population.

Investigators conducted a cross-sectional study evaluating patients who underwent immediate tissue expander-based breast reconstruction across a suburban health network between August 2021 and August 2023. Outcomes assessed included postoperative opioid use (measured in Oral Morphine Equivalents, OME), subjective pain scores, and length of stay (LOS). Among the 97 patients studied, 50 received liposomal bupivacaine and 43 did not. Patient groups were demographically similar, although anxiety (16% vs 2%) and comorbid conditions (27% vs 7%) were more prevalent in the liposomal bupivacaine group.

The analysis revealed no statistically significant differences in pain scores, LOS, or OME per hour between the two groups. However, multivariate regression analysis demonstrated that liposomal bupivacaine was independently associated with higher total OME consumption (coefficient = 0.61; 95% CI, 0.07–1.14; P = .026).

“Liposomal bupivacaine did not reduce postoperative opioid use, length of stay, or pain scores in patients undergoing tissue expander-based breast reconstruction,” the authors concluded.

Reference
Hoy OK, Reese V, Auger LJ, et al. Liposomal bupivacaine in immediate tissue expander-based breast reconstruction - is it worth the cost? Presented at: AAPS Annual Meeting; May 24-27, 2025; Austin, TX. Accessed April 25, 2025. https://meeting.aaps1921.org/