Pilot, randomized, placebo-controlled clinical field study to evaluate the effectiveness of bupivacaine liposome injectable suspension for the provision of post-surgical analgesia in dogs undergoing stifle surgery

Abstract

BackgroundLocal anesthetics are an important component of perioperative pain management, but the duration of action of available products is limited. We hypothesized that a single local infiltration of a novel bupivacaine liposome injectable suspension (AT-003) would provide clinically effective analgesia over a 72-h period.In a masked, randomized, placebo-controlled, multi-center pilot field study, dogs undergoing lateral retinacular suture placement for cranial cruciate insufficiency were randomly assigned to surgical site infiltration with AT-003 (5.3 mg/kg) or an equivalent volume of saline. Infiltration of the surgical site was done prior to closure. Primary outcome measure was the Glasgow Composite Measure Pain Scale (CMPS-SF) assessed prior to surgery and at 2, 4, 8, 12, 24, 30, 36, 48, 54, 60 and 72 h following surgery by trained individuals. Provision for rescue analgesia was employed. Repeated measures analysis of variance were utilized to test for possible differences between treatment groups and a success/failure analysis was also employed, based on the need for rescue analgesia.ResultsForty-six dogs were enrolled and evaluated. For CMPS-SF scores there was a significant overall treatment effect (p = 0.0027) in favor of AT-003. There were significantly more successes in the AT-003 group compared to placebo over each time period (p = 0.0001 for 0–24 h, p = 0.0349 for 0–48 h, and p = 0.0240 for 0-72 h). No significant adverse events were seen.ConclusionsAT-003 (bupivacaine liposome injectable suspension) provided measurable local analgesia over a 72-h period following post-stifle surgery surgical site tissue infiltration. Further work is indicated to develop this product for clinical use.Electronic supplementary materialThe online version of this article (doi:10.1186/s12917-016-0798-1) contains supplementary material, which is available to authorized users.

Local and regional anaesthesia in dogs and cats: Descriptions of specific local and regional techniques (Part 2)

“…Specific references for block technique and/or efficacy are provided where possible. 'Field block', also called incisional block or 'line' block (Vicente & Bergstrom, 2018;Lascelles, Rausch-Derra, Wofford, & Huebner, 2016;Yilmaz et al, 2014;Savvas et al 2008) Figure 1 and Box 3.…”

The effect of extracorporeal shockwave on liposomal bupivacaine in a tibial plateau leveling osteotomy model

“…3 Bupivacaine HCl, the longest-acting of these anesthetics, has an efficacy duration of 6 to 8 hours. 3,9,10 In 2016, a bupivacaine liposome injectable suspension (Nocita; Elanco Animal Health, Greenfield, Indiana) became commercially available for veterinary use. This bupivacaine suspension uses DepoFoam technology to safely provide local analgesia for up to 72 hours after surgical procedures in dogs and cats.…”

“…This bupivacaine suspension uses DepoFoam technology to safely provide local analgesia for up to 72 hours after surgical procedures in dogs and cats. [9][10][11] DepoFoam technology consists of multivesicular liposomes containing aqueous suspensions of bupivacaine. 1 The vesicles break down and release bupivacaine at a known rate, providing consistent and safe dosing of local anesthesia for extended periods of time.…”

“…12 Efficacy of liposomal bupivacaine injectable solution in dogs was first reported for use as a postoperative analgesic after surgical treatment of cranial cruciate ligament rupture by Lascelles and colleagues. 9 A routine lateral fabellar suture procedure was performed to stabilize the stifle joint, and a liposomal bupivacaine solution was infused into the soft tissue just prior to closure of the incision. Dogs that received the medication required significantly less rescue analgesia in the postoperative period compared with that dogs received placebo treatments.…”

“…Dogs that received the medication required significantly less rescue analgesia in the postoperative period compared with that dogs received placebo treatments. 9 Researchers in a subsequent study reported that dogs treated with liposomal bupivacaine after tibial plateau leveling osteotomy (TPLO) required significantly lower rescue doses of opioids compared with dogs treated with 0.5% bupivacaine HCl. 10 Extracorporeal shock wave therapy (ESWT) has been described as an effective nonpharmaceutical alternative to regional analgesia in man 14 and dogs 15,16 with orthopedic disease.…”