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Multimodal approaches are recommended to achieve effective postsurgical analgesia with reduced opioid reliance and are integral to enhanced recovery after surgery (ERAS) protocols. Transversus abdominis plane (TAP) block is a regional analgesia technique commonly used in colorectal ERAS protocols, particularly in the laparoscopic surgery setting. Clinical trial data demonstrate TAP block with liposomal bupivacaine ([LB]; Exparel®, bupivacaine liposome injectable suspension; Pacira Pharmaceuticals, Inc., Parsippany, NJ, USA) to be an effective opioid-sparing approach for controlling pain after colorectal surgery. However, clinical trials poorly address patient factors that might affect outcomes using this approach. This editorial provides the author’s personal experience and opinions regarding the optimal use of LB in multimodal management of somatic versus visceral pain and in complex cases, including patients with ulcerative colitis (UC) or other intense visceral inflammatory processes. Such patients are difficult to manage because of visceral pain, chronic opioid use, and increased opioid requirements and may require epidural analgesia and dose escalation. The author’s clinical experience suggests that TAP block with LB may not fully address visceral pain but can improve the somatic component, reducing the necessary epidural analgesia dose and allowing for the safe expansion of treatment options to include modalities that control visceral pain. Additional data are needed to further determine how patient factors such as comorbid disease affect efficacy and safety outcomes with this approach.

journal of pain research

Real-world insights on the use of transversus abdominis plane block with liposomal bupivacaine in the multimodal management of somatic versus visceral pain in the colorectal surgery setting