EXPAREL® (Long-Acting Liposomal Bupivacaine) Use for Popliteal Nerve Block in Postoperative Pain Control after Ankle Fracture Fixation

Discepola, Patrick; Bouhara, Mohamed; Kwon, Minho; Siddiqui, Bilal A.; Whitwell, Trevor A; Sanghvi, Swetha Y; Cook, Keith D.; Moore, Ross E; Korban, Anna; Eloy, Jean Daniel

doi:10.1155/2020/5982567

Cited by 8 publications

(5 citation statements)

References 18 publications

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“…In a pilot study published in 2015, Ilfeld et al 40 demonstrated similar safety profiles among LB, traditional bupivacaine, and placebo when used in regional nerve blocks. Furthermore, research for its applications in epidural, 41 popliteal, 42 and femoral nerve 43 blocks is promising. However, other literature suggests that the evidence is inadequate to suggest routine use in regional anesthesia 44–46 .…”

Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of Liposomal Bupivacaine Supraclavicular Nerve Blocks in Open Treatment of Distal Radius Fractures

et al. 2023

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Introduction: Distal radius fractures (DRFs) are common fractures requiring surgical fixation. The literature varies regarding opioid prescribing habits, opioid consumption, and postoperative pain scores. We hypothesized that the preoperative administration of a liposomal bupivacaine (LB) supraclavicular nerve block would be safe and effective in controlling postoperative pain. Methods: A standardized pain management protocol was implemented at a single institution from July 2021 to March 2022 for patients undergoing open reduction internal fixation of DRF. Protocol elements included a preoperative LB supraclavicular nerve block and a multimodal postoperative pain regimen. Primary clinical outcomes included postoperative pain scores and number of opioid tablets consumed. Results: Twenty patients underwent a newly implemented protocol. The average age was 56 years. Mean number of oxycodone 5-mg tablets consumed was 4.1 (median, 2.5), and mean visual analog scale pain score at first postoperative appointment was 2.8. There were no incidences of missed acute carpal tunnel postoperatively. When compared with an institutional historical control (n = 189), number of opioid pills prescribed was reduced by 60% (21.4 vs 8.6 tablets, P < 0.0001), and no patients had unscheduled health care contact because of uncontrolled pain (22% vs 0%, P < 0.016). Conclusions: Liposomal bupivacaine supraclavicular nerve blocks are safe and effective in the treatment of postoperative pain after open reduction internal fixation of DRF. Patients consumed <5 oxycodone tablets on average, which is less than many recommend prescribed quantities (>20-30 tablets). Patients had low pain scores (2.8/10) at the first postoperative follow-up. To our knowledge, this is the first study demonstrating the utility of LB in this clinical setting.

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Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of Liposomal Bupivacaine Supraclavicular Nerve Blocks in Open Treatment of Distal Radius Fractures

et al. 2023

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“…This formulation has been reported to relieve regional pain for up to 72 hours postoperatively, compared to other regional anesthetics which last around six to 24 hours after injection, depending on formulation and location (17,18). The Food and Drug Administration has approved liposomal bupivacaine for transversus abdominis plane and interscalene nerve blocks, but additional uses are being investigated (19,20).…”

Section: Discussionmentioning

confidence: 99%

Pain Management and Opioid Use with Long-Acting Peripheral Nerve Blocks for Hand Surgery: A Descriptive Study

Knopp,

Eng,

Esmaeili

2023

Anesth Pain Med

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Background: Peripheral nerve blocks (PNBs) are used in multiple surgical fields to provide a high level of regional pain relief with a favorable adverse effect profile. PNBs aim to decrease overall perioperative pain and lower systemic analgesic requirements. Short-acting anesthetic agents are commonly given as single-injection PNBs for pain relief, typically lasting less than 24 hours. Liposomal bupivacaine is a newer anesthetic formulation lasting up to 72 hours as a single-injection PNB and may allow patients to recover postoperatively with a lower need for opioid analgesics. Objectives: This study investigates peri- and postoperative pain and opioid use in patients receiving a long-acting brachial plexus PNB for hand surgery. Methods: A retrospective review of patients who underwent a long-acting PNB using liposomal bupivacaine in the brachial plexus for minor hand operations was performed between July 2020 and May 2023 in Florida, USA. Patients were administered a ten-question survey regarding perioperative pain levels, post-operative symptoms, patient satisfaction, postoperative opioid use, and postoperative non-opioid analgesics. Results: One hundred three patients, including 21 males and 82 females with an average age of 68.3 ± 15.8 years, completed a survey (34.2% response rate). Patients reported a considerable reduction in pain from 7.9 ± 2.2 out of ten before the PNB to 1.6 ± 1.8 in the perioperative period, 4.3 ± 2.7 in postoperative days zero to three, and 3.8 ± 2.4 in postoperative days four and five. Nerve block effects lasted a mean of 2.2 ± 2.0 days and patients reported a high level of satisfaction regarding their pain management plan with a score of 9.4 ± 1.4 out of ten. 20.4% of patients were prescribed opioids and 41.7% used NSAIDs postoperatively. Conclusions: Liposomal bupivacaine PNBs effectively reduced peri- and postoperative pain with pain relief lasting 2.2 ± 2.0 days. Patients were highly satisfied with their pain management and there was a low rate of postoperative opioid prescription. Given these results, long-acting PNBs have the potential to significantly improve patient satisfaction, reduce anesthesia use, and reduce postoperative opioid prescription.

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“…The half-life of the drug is 13.4-31.4 hours depending on the administered dose (Chahar & Cummings, 2012;Hu et. al., 2013;Burbridge & Jaffe, 2015;Aggarwal, 2018;Discepola et al, 2020;Markova et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

Regional anesthesiological support for the implementation of surgical interventions in the abdomen of dogs

Sliusarenko

Ilnitskiy

Bilyi

et al. 2021

Regul. Mech. Biosyst.

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Widespread use of surgical interventions in the abdomen of dogs determines the relevance of the study. The research tested the influence of therapeutic epidural blockade with 0.2% bupivacaine after surgical interventions on the background of potentiated local anaesthesia on the body of clinically healthy dogs undergoing ovariohysterectomy. In the control group postoperative analgesia was performed with the nonsteroidal anti-inflammatory drug rimadyl on the background of potentiated thiopental anaesthesia. Wound healing rates were determined in 10 animals of both control and experimental groups; blood counts and the level of inflammatory response were indicated in 5 animals of each group. The dynamics of reparative processes and complete wound healing in dogs of the experimental group occurred earlier than in animals of the control group, which confirmed the fact that the use of bupivacaine had a beneficial effect on tissue regeneration. The results of morphological and biochemical parameters of blood in animals of the experimental group manifested only an increase of leukocytes by 1.58 times, fibrinogen by 2.02 times, while in dogs of the control group the level of erythrocytes, haemoglobin and hematocrit decreased, leukocytes increased by 1.74 times, platelets decreased by 2.87 times and fibrinogen increased by 1.72 times. Among the stress response markers in the control group there was a 1.94 times increase in glucose level after surgery. In the experimental group there was a decrease in the intensity of the inflammatory reaction in dogs, accompanied by an increase of anti-inflammatory interleukin 4 (IL-4) only on the seventh day – 1.86 times, while in the control group the level of anti-inflammatory interleukin 1 receptor antagonist (IL-1RA) after three days increased by 2.30 times, after seven days – by 2.48 times, and the level of proinflammatory interleukin 6 (IL-6) after surgery increased by 2.57 times. It will be promising to conduct further research on the influence of therapeutic blockades with bupivacaine in animals in cases of various surgical interventions and pathological conditions, which will lead to faster recovery of animals and alleviate pathological processes.

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EXPAREL® (Long-Acting Liposomal Bupivacaine) Use for Popliteal Nerve Block in Postoperative Pain Control after Ankle Fracture Fixation

Cited by 8 publications

References 18 publications

Safety and Efficacy of Liposomal Bupivacaine Supraclavicular Nerve Blocks in Open Treatment of Distal Radius Fractures

Safety and Efficacy of Liposomal Bupivacaine Supraclavicular Nerve Blocks in Open Treatment of Distal Radius Fractures

Pain Management and Opioid Use with Long-Acting Peripheral Nerve Blocks for Hand Surgery: A Descriptive Study

Regional anesthesiological support for the implementation of surgical interventions in the abdomen of dogs

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