Peripheral Nerve Blockade with Combined Standard and Liposomal Bupivacaine in Major Lower‐Extremity Amputation

Abstract

Background and Objectives: Optimizing perioperative analgesia for patients undergoing major lower-extremity amputation remains a considerable challenge. The utility of liposomal bupivacaine as a component of peripheral nerve blockade for lower-extremity amputation is unknown. Methods: We conducted an observational study comparing three different perioperative analgesic techniques for adults undergoing major lower-extremity amputation under general anesthesia between 2012 and 2017 at an academic medical center: (1) no regional anesthesia, (2) peripheral

The Efficacy of Liposomal Bupivacaine in Regional Nerve Blocks for Below Knee Amputations

“…LB offers a unique solution compared to peripheral nerve catheters as it offers a single injection, which theoretically could improve patient comfort, minimize infectious risk, and decrease overall cost. 1 Lastly, our sample size was relatively small, which could limit the generalizability of our study. In the future it would be interesting to explore the difference in OME between nerve blocks with LB, without LB, and peripheral nerve catheters.…”

“…Numerous analgesic modalities have been described such as opioids, peripheral nerve blocks, and perineural catheters. 1,2 Liposomal bupivacaine (LB) was introduced as a formulation of the local anesthetic bupivacaine to increase the duration of drug release up to 72 hours after administration. 1,2 The increased duration of release could potentially provide a significant clinical benefit with one injection.…”

“…1,2 Liposomal bupivacaine (LB) was introduced as a formulation of the local anesthetic bupivacaine to increase the duration of drug release up to 72 hours after administration. 1,2 The increased duration of release could potentially provide a significant clinical benefit with one injection. 1,2 Currently, the use of LB as a nerve block for lower extremity amputations is off-label, and there is little data comparing it to other strategies.…”

“…1,2 The increased duration of release could potentially provide a significant clinical benefit with one injection. 1,2 Currently, the use of LB as a nerve block for lower extremity amputations is off-label, and there is little data comparing it to other strategies. 1,2 The goal of our retrospective study was to assess postoperative opioid consumption after LB regional nerve blocks in below knee amputation (BKA) procedures compared to no regional nerve blocks.…”

“…Chronic pain has been estimated to occur in up to 80% of patients after a major amputation, and some evidence suggest that it may be minimized with an optimized postoperative pain regimen. 1,2 The pathophysiology of amputation pain is multifactorial; therefore, the emphasis for a multimodal pain regimen is essential. Numerous analgesic modalities have been described such as opioids, peripheral nerve blocks, and perineural catheters.…”