Reduced movement-evoked pain with liposomal bupivacaine versus ropivacaine in transversus abdominis plane block for laparoscopic colorectal surgery: a randomized controlled trial

The analgesic efficacy of liposomal bupivacaine (LB) for transversus abdominis plane block (TAPB) in laparoscopic colorectal surgery (LCS) remains controversial. This trial aimed to determine whether LB provides better analgesia and recovery outcomes than ropivacaine for TAPB. In this randomized, double-blind trial, 136 patients undergoing LCS were randomly allocated (1:1) to receive bilateral TAPB with either LB (266 mg total, 133 mg per side) or ropivacaine (0.375%, 20 mL per side). The primary outcome was the area under the curve (AUC) of the visual analogue scale (VAS) for movement-evoked pain (MEP) over 72 h. Secondary outcomes included intraoperative remifentanil consumption, the AUC of VAS for pain at rest (PAR), International Pain Outcome Questionnaire (IPOQ) scores, and the incidence of chronic pain. Compared with ropivacaine, LB significantly reduced AUC of the VAS for MEP (median difference: -20.15; 95% CI: -33.25, -2.35; P = 0.001); intraoperative remifentanil consumption (-59.75 µg; 95% CI: -142.00, -9.50; P = 0.001); sleep disturbance (-0.5; 95% CI: -1.0, 0; P = 0.002) and pain interference with out-of-bed activities (-1; 95% CI: -1, 0; P = 0.014). No significant intergroup differences were observed in the AUC of the VAS for PAR or chronic pain at 3 months. In LCS patients, liposomal bupivacaine significantly reduces movement-evoked pain, improves intraoperative analgesia, enhances sleep quality, and alleviates pain-related interference with activity within 72 h postoperatively. However, these benefits did not translate into a reduction in pain at rest or the incidence of chronic pain. Chinese Clinical Trial Registry, ChiCTR2400082663. Registered on April 3, 2024. • Liposomal bupivacaine was superior to ropivacaine in reducing movement-evoked pain after laparoscopic colorectal surgery. • It reduced intraoperative remifentanil consumption and improved postoperative sleep quality. • Liposomal bupivacaine also minimized pain interference with patient activities.