Postoperative Pain Advances: Lidocaine Patch Trial, Liposomal Bupivacaine Protocol, and Pipeline Report

Recent developments in postoperative pain management include a randomized trial showing that lidocaine patches reduced opioid use after radiofrequency ablation for hepatocellular carcinoma, a protocol for a randomized trial testing liposomal bupivacaine in serratus anterior plane block for modified radical mastectomy, and a pipeline report covering more than 40 companies developing postoperative pain therapies.

In a study published in Cancer Medicine, patients undergoing radiofrequency ablation (RFA) for early-stage hepatocellular carcinoma were randomly assigned to receive lidocaine patches or placebo patches. A total of 86 patients in the lidocaine patch group and 68 in the placebo group completed the study. Pain scores did not differ between the two groups at any time point. However, the equivalent cumulative dose of residual morphine was lower in the lidocaine patch group, with statistically significant differences at time points T4–T6 (p = 0.032, p = 0.018, and p = 0.032, respectively). After adjusting for confounding factors, multiple linear regression analysis yielded similar results. The study concluded that the lidocaine patch may be useful to reduce opioid use post-RFA. The trial was registered at ClinicalTrials.gov with identifier NCT05732181.

Serratus anterior plane block (SAPB) is increasingly used as part of multimodal analgesia for breast surgery, but published evidence on liposomal bupivacaine in SAPB for modified radical mastectomy remains limited. Another trial is evaluating whether adding liposomal bupivacaine to bupivacaine hydrochloride for SAPB improves pain-related and early recovery outcomes after modified radical mastectomy. The prospective, randomized, double-blind, controlled trial will enroll 76 patients undergoing elective modified radical mastectomy for breast cancer, randomly assigned in a 1:1 ratio to receive unilateral ultrasound-guided SAPB with either liposomal bupivacaine plus bupivacaine HCl or bupivacaine HCl alone. The primary endpoint is the Quality of Recovery-15 score at 24 hours postoperatively. Secondary outcomes include postoperative pain intensity up to 72 hours, opioid-related outcomes expressed as morphine milligram equivalents, QoR-15 scores at 48 and 72 hours, time to first demand of patient-controlled analgesia, Overall Benefit of Analgesia Score, postoperative nausea and vomiting, sleep quality, perioperative complications, and patient-reported neuropathic pain symptoms at 3 months. The trial is registered with the Chinese Clinical Trial Registry under number ChiCTR2500111732.

The 'Postoperative Pain - Pipeline Insight, 2026' report profiles over 40 companies and 50 pipeline drugs shaping the postoperative pain landscape. Emerging drugs include PF614 (Ensysce Biosciences), an oxycodone-based medication chemically modified to remain inactive until digested, currently in Phase III trials; ATX101 (Allay Therapeutics), a sodium ion channel blocker and biopolymer configuration designed for extended relief after knee arthroplasty, in Phase II trials; LC-400 (LipoCure), an ultra-long-acting local anesthetic advancing to Phase II trials; and GB-6002 (G2GBIO), an extended-release ropivacaine injectable promising over three days of pain relief with a single dose, currently in Phase I trials.

Postoperative pain results from tissue damage and inflammation following surgery and involves neurological and psychological factors. Effective management is vital for recovery, as unmanaged pain can delay healing and may lead to chronic conditions. Acute pain after surgery is temporary, while chronic pain can last over three months in a significant percentage of patients. Management techniques include multimodal analgesia, where a combination of drugs provides better pain relief with fewer side effects than a single agent, and opioid analgesia, commonly featuring morphine, hydromorphone, and fentanyl.