Bupivacaine liposome injectable suspension compared with bupivacaine HCl for the reduction of opioid burden in the postsurgical setting

Dasta, Joseph F.; Ramamoorthy, Sonia; Patou, Gary; Sinatra, Raymond S.

doi:10.1185/03007995.2012.721760

Cited by 137 publications

(98 citation statements)

References 24 publications

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“…After approximately 72 hours, when the liposomal bupivacaine effect has worn off, the narcotic consumption in the two groups of patients was not statistically different. Dasta et al [8] demonstrated findings favoring liposomal bupivacaine compared with patient-controlled analgesia in a combined gastrointestinal and orthopaedic surgery trial, in which they reported reductions in pain intensity scores, as measured by a pooled area under the curve analysis, and reductions in total opioid use over 72 hours postoperatively. The clinically related significance of the reduction in pain scores remains unclear; however, they found a reduction in opioid-related adverse events in patients receiving liposomal bupivacaine.…”

Section: Discussionmentioning

confidence: 99%

Pain Control and Functional Milestones in Total Knee Arthroplasty: Liposomal Bupivacaine versus Femoral Nerve Block

Szulc

Walton

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background Although pain management after total knee arthroplasty (TKA) affects rehabilitation, length of stay, and functional outcomes, pain management for patients undergoing TKA has yet to be standardized. Femoral nerve blocks (FNBs) are commonly used as an adjunct; however, these can result in transient quadriceps weakness and have been associated with in-hospital falls. Periarticular infiltration of liposomal bupivacaine has been recently introduced as a long-acting analgesic that can be administered without affecting motor function. Questions/purposes (1) Does periarticular liposomal bupivacaine compared with FNB result in improved pain control as measured by pain scores and narcotic consumption? (2) How do liposomal bupivacaine and FNB compare in terms of gait and stairclimbing milestones and the proportion of patients who experienced a fall in the hospital?Methods Between September 2013 and October 2014, a retrospective analysis was conducted involving 24 surgeons who performed a total of 1373 unilateral, primary TKAs. From September 2013 to April 2014, the routine approach to TKA pain management pathway consisted of preoperative administration of oral analgesics, intraoperative anesthesia (preferred spinal or general), an ultrasound-guided FNB, intraoperative analgesic cocktail injection, patient-controlled analgesia, and oral and IV narcotics for pain as needed. A total of 583 patients were included in this study group. Starting May 2014, FNBs were discouraged and there was department-wide adoption of liposomal bupivacaine. Liposomal bupivacaine became routinely used in all patients undergoing TKA with no other changes made to the multimodal analgesia protocol at that time, and 527 patients in this study group were compared with the FNB cohort. Chart review on a total of 1110 patients was conducted by a research assistant who was not participating in patient care. During the inpatient stay, pain scores during 8-hour intervals, narcotic use, and physical therapy milestones were compared. Results With the numbers available, we detected no clinically important difference in pain scores throughout the hospital stay; however, patients treated with liposomal bupivacaine consumed very slightly less narcotics overall (96 ± 62 versus 84 ± 73 eq mg of morphine; [95% confidence interval, 11-13 mg]; p = 0. Conclusions In the absence of strong data supporting FNB over liposomal bupivacaine, we have modified our TKA pain management protocols by adopting liposomal bupivacaine in lieu of FNBs, facilitating rapid rehabilitation while providing adequate pain control. Level of Evidence Level III, therapeutic study.

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Section: Discussionmentioning

confidence: 99%

Pain Control and Functional Milestones in Total Knee Arthroplasty: Liposomal Bupivacaine versus Femoral Nerve Block

Szulc

Walton

et al. 2017

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

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“…It has been proposed that liposomal bupivacaine can improve the duration of effectiveness for PAI and thus may provide sufficient analgesia while also reducing the amount of opioid medications delivered for effective pain control. The current study occurred in settings that already had established total joint pathways in place, including preoperative education [70], patient-focused care initiatives [3,17,19,36,43,45,60,67,87], multimodal analgesia regimens [9,10,16,20,24,26,35,38,53,72,76,78,80,83], and postoperative rehabilitation pathways [16,51,77] to focus the results on the three randomized treatment groups described. We found that the primary outcome measure of pain control was better at 6 and 12 hours postoperatively in the liposomal bupivacaine PAI and spinal morphine groups compared with the ropivacaine PAI group.…”

Section: Discussionmentioning

confidence: 99%

No Difference in Early Analgesia Between Liposomal Bupivacaine Injection and Intrathecal Morphine After TKA

Barrington

Emerson

Lovald

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background Opioid analgesics have been a standard modality for postoperative pain management after total knee arthroplasty (TKA) but are also associated with increased risk of nausea, pruritus, vomiting, respiratory depression, prolonged ileus, and cognitive dysfunction.There is still a need for a method of anesthesia that can deliver effective long-term postoperative pain relief without incurring the high cost and health burden of opioids and nerve blocks. Questions/purposes (1) Is liposomal bupivacaine-based periarticular injection (PAI) more effective than morphinebased spinal anesthesia or ropivacaine-based PAI in

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“…14 Liposome bupivacaine has been shown to provide postsurgical analgesia across a range of surgical models, with a safety profile that is similar to that of bupivacaine HCl. [15][16][17] While available data in volunteers suggest that liposome bupivacaine in a femoral nerve block results in prolonged blockade, 18 its analgesic effects when used in a peripheral nerve block in a setting of acute postsurgical pain remain unknown.…”

mentioning

confidence: 99%

Liposome Bupivacaine Femoral Nerve Block for Postsurgical Analgesia after Total Knee Arthroplasty

et al. 2016

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Background The authors evaluated the efficacy of liposome bupivacaine in a femoral nerve block (FNB) after total knee arthroplasty. Methods Part 1: subjects received FNB with 20 ml liposome bupivacaine (67, 133, or 266 mg) or placebo. Part 2: subjects were randomized to FNB with liposome bupivacaine 266 mg or placebo. The primary outcome measure was area under the curve of the numeric rating scale score for pain intensity at rest through 72 h (AUC NRS-R0–72) with imputed scores after rescue medication. Results In part 1, FNB with liposome bupivacaine 266 mg (n = 24) resulted in analgesia similar to that obtained with 133 mg and was chosen for part 2. In part 2, least-squares mean (standard error) AUC NRS-R0–72 was lower with liposome bupivacaine 266 mg (n = 92) than with placebo (n = 91; 419 [17] vs. 516 [17]; P < 0.0001). This outcome remained unchanged in a post hoc analysis without score imputation (221 [12] vs. 282 [12]; P = 0.0005). Least-squares mean AUC NRS-R with imputed scores was lower with liposome bupivacaine during each 24-h interval (0 to 24, 24 to 48, and 48 to 72 h) after surgery; AUC NRS-R without imputed scores was lower during the 0- to 24-h and 24- to 48-h intervals. The liposome bupivacaine group had lower mean total opioid use (76 vs. 103 mg morphine; P = 0.0016). Pain was sufficiently severe to require second-step rescue with opioids via intravenously administered patient-controlled analgesia in 92% of liposome bupivacaine patients and 81% of placebo patients. With patient-controlled analgesia and other forms of rescue analgesia, mean NRS scores with activity were moderate in both liposome bupivacaine and placebo groups throughout the part 2 study period. Incidence of adverse events was similar between the groups (part 1: 90 vs. 96%; part 2: 96 vs. 96%, respectively). Conclusion FNB with liposome bupivacaine (266 mg) resulted in modestly lower pain scores and reduced opioid requirements after surgery, with an adverse event profile similar to placebo.

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Bupivacaine liposome injectable suspension compared with bupivacaine HCl for the reduction of opioid burden in the postsurgical setting

Cited by 137 publications

References 24 publications

Pain Control and Functional Milestones in Total Knee Arthroplasty: Liposomal Bupivacaine versus Femoral Nerve Block

Pain Control and Functional Milestones in Total Knee Arthroplasty: Liposomal Bupivacaine versus Femoral Nerve Block

No Difference in Early Analgesia Between Liposomal Bupivacaine Injection and Intrathecal Morphine After TKA

Liposome Bupivacaine Femoral Nerve Block for Postsurgical Analgesia after Total Knee Arthroplasty

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