Comparing Local Anesthetics for Postoperative Pain Management in Outpatient Cosmetic Surgery: A Randomized Controlled Trial

Background: Effective postoperative pain management is essential in outpatient cosmetic surgery to enhance recovery and minimize opioid use. While local anesthetics are routinely used, particularly liposomal bupivacaine, the comparative efficacy of specific agents remains uncertain. Objective: To compare the analgesic efficacy of 4 local anesthetics, liposomal bupivacaine, standard bupivacaine, a ropivacaine-ketorolac-epinephrine (NERK) solution, and lidocaine, against saline placebo following bilateral cosmetic procedures. Methods: In this randomized, double-blind, within-subject controlled trial, 50 patients undergoing bilateral breast or body contouring surgery received 2 different local anesthetics—1 on each side. Pain scores were recorded on a 0 to 10 numerical rating scale at 1, 4, 7, 12, 24, 48, and 72 hours postoperatively. Statistical comparisons were made using the Kruskal-Wallis, repeated measures analysis of variance (ANOVA), and Wilcoxon signed-rank tests. Results: No statistically significant differences in postoperative pain scores were observed between treatment groups at any time point ( P > .05). Intra-patient comparisons revealed small, inconsistent differences across agents. Notably, a post hoc power analysis indicated the study may have been underpowered to detect subtle but potentially meaningful differences in analgesic efficacy. Conclusion: This study found no significant advantage of one local anesthetic over another in reducing postoperative pain following outpatient cosmetic surgery. However, the findings should be interpreted with caution given the likelihood of type II error due to limited sample size. The presumed superiority of liposomal bupivacaine was not supported, raising further questions about its cost-effectiveness. Future studies with larger cohorts are warranted, and emphasis should remain on multimodal analgesia to optimize pain control and minimize opioid use.