Authors: Turan A et al.
Anesthesiology, December 2025. DOI: 10.1097/ALN.0000000000005869
Summary
This randomized, triple-blinded clinical trial (CLEVELAND Trial) compared liposomal bupivacaine, plain bupivacaine, and saline for pre-incision, single-shot four-quadrant transversus abdominis plane (TAP) blocks in patients undergoing major abdominal surgery. The study tested whether liposomal bupivacaine reduces postoperative opioid consumption more effectively than plain bupivacaine or saline.
A total of 261 patients were included in the modified intention-to-treat analysis. During the first 24 postoperative hours, opioid use was similar across groups: 26 MME with liposomal bupivacaine, 33 MME with plain bupivacaine, and 31 MME with saline, with no statistically significant differences. Between 24–48 hours, opioid consumption again showed no meaningful group differences. Secondary outcomes—including pain scores, time to sensory return, and opioid use from 48–72 hours—were also comparable among all groups.
Overall, neither liposomal nor plain bupivacaine demonstrated analgesic superiority over placebo when TAP blocks were administered before incision for mixed open and laparoscopic abdominal procedures.
Key Points
• Liposomal bupivacaine did not reduce opioid use compared with plain bupivacaine or saline at 24 or 48 hours.
• Pain scores and opioid consumption from 48–72 hours were similar across all groups.
• Results question the value of routine pre-incision, single-shot TAP blocks for heterogeneous abdominal surgical procedures.
• Findings suggest minimal clinical benefit to using liposomal bupivacaine in TAP blocks for this population.
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