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Video

Head and Neck Surgery

(A559) Impact of Liposomal Bupivacaine on Post-operative Pain, Opioid Use, and Swallow in Transoral Robotic Surgery

Monday, October 13, 2025
12:00 PM - 1:00 PM EDT
Location: OTO EXPO, Posters

    Presenting Author(s)

  • Kavya Pai, MD

    Resident Physician
    Geisinger Health System
    Danville, Pennsylvania, United States

    • Co-Author(s)

  • Kavya Pai, MD

    Resident Physician
    Geisinger Health System
    Danville, Pennsylvania, United States

  • Phillip K. Pellitteri, DO

    Clinical Professor, Geisinger Commonwealth School of Medicine
    Geisinger Health System
    Bloomsburg, PA, United States

  • Kevin J. Kovatch, MD

    Assistant Professor, Attending Surgeon
    Geisinger Medical Center - ENT
    Danville, PA, United States

  • NP

    Nicholas C. Purdy, DO

    Director of Head and Neck Surgery
    Geisinger Health
    Danville, Pennsylvania, United States

  • TH

    Thorsen W. Haugen, MD

    Associate Professor
    Geisinger Medical Center
    Danville, Pennsylvania, United States

    • Senior Author(s)

  • TH

    Thorsen W. Haugen, MD

    Associate Professor
    Geisinger Medical Center
    Danville, Pennsylvania, United States

Disclosure(s):
Kavya Pai, MD: No relevant relationships to disclose.
Nicholas C. Purdy, DO: No relevant relationships to disclose.


Introduction: This study aims to assess how liposomal bupivacaine (LB) impacts postoperative pain, opioid use, and swallow function in patients undergoing transoral robotic surgery (TORS).

Methods: All adult patients undergoing TORS for the treatment of HPV-mediated oropharyngeal squamous cell carcinoma (SCCa) between July 2022-present were included in this retrospective observational cohort study. The two cohorts included patients who received intraoperative LB and patients who did not. Outcome measures included length of stay (LOS), mean pain (measured by a Visual Analog Scale), mean opioid use (measured in Morphine Milligram Equivalents), pre-operative MD Anderson Dysphagia Inventory (MDADI) composite score, pre-operative functional endoscopic evaluation of swallow Dynamic Imaging Grade of Swallowing Toxicity (FEES – DIGEST) score, post-operative MDADI score, and post-operative FEES- DIGEST score.

Results: Preliminary data includes 20 patients, 12 (60%) of whom received intraoperative LB while 8 patients (40%) did not. There was no significant difference in the LOS between the two groups [3.42 (LB) v 3.50 (No LB) days, p= 0.916]. Patients who did not receive LB reported less mean pain (3.15 v. 1.30, p = 0.09), though they used more opioid (5.01 v. 1.76 MME) (p = 0.090) medications on post-operative day 0. On post-operative day 2, patients who received LB demonstrated significantly higher mean pain scores compared to their counterparts (4.12 v 1.10, p < 0.001). Post-operative MDADI composite scores (71.67 v. 68.50, p = 0.737) and FEES- DIGEST scores (3.08 v. 3.00, p = 1.00) were not significantly different between the two groups.

Conclusions: Initial data from this study suggest that intraoperative use of LB does not have a significant impact on pain, opioid usage, and swallow function in patients undergoing TORS for treatment of HPV-mediated SCCa. It is possible that mean pain increases in those who receive LB as the effects of the anesthetic diminish.