Liposome Bupivacaine for Postoperative Analgesia: One Formulation Approved for Clinical Use Within the United States

Charous, Matthew T.; Ilfeld, Brian M.

doi:10.1007/s40140-015-0105-x

Cited by 5 publications

(5 citation statements)

References 25 publications

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“…Although the recently published evidence presented in this review helps to clarify questions previously unanswered, many unknown aspects of CPNB persist. Although the data demonstrating perineural local anesthetic infusion's many benefits continue to grow in quality, breadth, and depth, both older 280,282,298,423 and novel 307,352,354,424 analgesic alternatives must be considered and investigated. Only through persistent, unbiased investigation will we be able to optimize analgesia for patients, whether from CPNB or an alternative modality.…”

Section: Discussionmentioning

confidence: 99%

“…310,312 Although multiple subsequent reports were published, [313][314][315][316][317][318][319][320][321] a liposome local anesthetic was not approved by the US FDA until 2011 (Exparel liposome bupivacaine; Pacira Pharmaceuticals, Parsippany, NJ) for administration at the surgical site to provide postoperative analgesia in adults. 307 Two multicenter RCTs demonstrated superior postoperative analgesia of this approved medication compared with placebo wound infiltration after hemorrhoidectomy 322 and bunionectomy. 323 In contrast, when compared with bupivacaine HCl ("standard" bupivacaine), 10 of the 12 currently published RCTs were negative for their primary (and most secondary) analgesic end points.…”

Section: Liposome Local Anestheticmentioning

confidence: 98%

“…Liposomes consist of 2 hydrophobic tails and a hydrophilic head 305 and can form vesicles to act as a medication "depot" (Figure 1). 306,307 After administration, the liposomes gradually break down, resulting in an extended release of medication. 308,309 Combining liposomes and a local anesthetic (lidocaine) was first proposed in 1979, 310 initially used in humans in 1988, 311 and first reported for postoperative analgesia in 1994.…”

Section: Liposome Local Anestheticmentioning

confidence: 99%

“…Although no liposome local anesthetic is currently approved for use within the epidural space 339 or peripheral nerve blocks, a great deal of related research has been completed (if not all published). 307 Both preclinical toxicology and clinical data indicate that liposome bupivacaine has a safety profile at least as favorable as bupivacaine HCl. [340][341][342][343][344][345][346][347][348][349][350] Although phase 1 to 3 clinical trials involving the use of liposome bupivacaine have been reported for intercostal and ankle blocks, 306,307,340 the most published data may be found for femoral nerve blocks.…”

Section: Liposome Local Anestheticmentioning

confidence: 99%

“…307 Both preclinical toxicology and clinical data indicate that liposome bupivacaine has a safety profile at least as favorable as bupivacaine HCl. [340][341][342][343][344][345][346][347][348][349][350] Although phase 1 to 3 clinical trials involving the use of liposome bupivacaine have been reported for intercostal and ankle blocks, 306,307,340 the most published data may be found for femoral nerve blocks. 351,352 No direct comparisons with CPNB are available, but liposome bupivacaine in a femoral nerve block produced over 72 hours of analgesia with an incomplete motor block in healthy volunteers 351 and demonstrated analgesic activity for up to 72 hours versus placebo in subjects after total knee arthroplasty (albeit extraordinarily minimal analgesic differences after 24 hours).…”

Section: Liposome Local Anestheticmentioning

confidence: 99%

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Continuous Peripheral Nerve Blocks: An Update of the Published Evidence and Comparison With Novel, Alternative Analgesic Modalities

Ilfeld

2017

Anesthesia &Amp; Analgesia

Self Cite

287

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A continuous peripheral nerve block (CPNB) consists of a percutaneously inserted catheter with its tip adjacent to a target nerve/plexus through which local anesthetic may be administered, providing a prolonged block that may be titrated to the desired effect. In the decades after its first report in 1946, a plethora of data relating to CPNB was published, much of which was examined in a 2011 Anesthesia & Analgesia article. The current update is an evidence-based review of the CPNB literature published in the interim. Novel insertion sites include the adductor canal, interpectoral, quadratus lumborum, lesser palatine, ulnar, superficial, and deep peroneal nerves. Noteworthy new indications include providing analgesia after traumatic rib/femur fracture, manipulation for adhesive capsulitis, and treating abdominal wall pain during pregnancy. The preponderance of recently published evidence suggests benefits nearly exclusively in favor of catheter insertion using ultrasound guidance compared with electrical stimulation, although little new data are available to help guide practitioners regarding the specifics of ultrasound-guided catheter insertion (eg, optimal needle-nerve orientation). After some previous suggestions that automated, repeated bolus doses could provide benefits over a basal infusion, there is a dearth of supporting data published in the past few years. An increasing number of disposable infusion pumps does now allow a similar ability to adjust basal rates, bolus volume, and lockout times compared with their electronic, programmable counterparts, and a promising area of research is communicating with and controlling pumps remotely via the Internet. Large, prospective studies now document the relatively few major complications during ambulatory CPNB, although randomized, controlled studies demonstrating an actual shortening of hospitalization duration are few. Recent evidence suggests that, compared with femoral infusion, adductor canal catheters both induce less quadriceps femoris weakness and improve mobilization/ambulation, although the relative analgesia afforded by each remains in dispute. Newly published data demonstrate that the incidence and/or severity of chronic, persistent postsurgical pain may, at times, be decreased with a short-term postoperative CPNB. Few new CPNB-related complications have been identified, although large, prospective trials provide additional data regarding the incidence of adverse events. Lastly, a number of novel, alternative analgesic modalities are under development/investigation. Four such techniques are described and contrasted with CPNB, including single-injection peripheral nerve blocks with newer adjuvants, liposome bupivacaine used in wound infiltration and peripheral nerve blocks, cryoanalgesia with cryoneurolysis, and percutaneous peripheral nerve stimulation.

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