Prolonged Duration Local Anesthesia Using Liposomal Bupivacaine Combined With Liposomal Dexamethasone and Dexmedetomidine

Rwei, Alina Y.; Sherburne, Robert; Zurakowski, David; Wang, Bruce; Kohane, Daniel S.

doi:10.1213/ane.0000000000002719

Cited by 34 publications

(30 citation statements)

References 32 publications

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“…Although there are multiple adjuvants that could extend the duration of local anesthetics, it was worth noting that the ability of adjuvants to prolong nerve block may have a ceiling. 18 Similar effect might not have been achieved by simply increasing the dosage of dexamethasone or dexmedetomidine. In the context of that knowledge, we raised the question: could the combination of two adjuvants further prolong the duration of nerve block?…”

Section: Discussionmentioning

confidence: 99%

Dexamethasone and dexmedetomidine as adjuvants to local anesthetic mixture in intercostal nerve block for thoracoscopic pneumonectomy: a prospective randomized study

Zhang

Liu

Jing-ming

et al. 2019

Reg Anesth Pain Med

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Background and objectivesPerineural dexamethasone or dexmedetomidine prolongs the duration of single-injection peripheral nerve block when added to the local anesthetic solution. In a randomized, controlled, double-blinded study in patients undergoing thoracoscopic pneumonectomy, we tested the hypothesis that combined perineural dexamethasone and dexmedetomidine prolonged the duration of analgesia as compared with either perineural dexamethasone or perineural dexmedetomidine after intercostal nerve block (INB).MethodsEighty patients were randomized to receive INB using 28 mL 0.5% ropivacaine, with 2 mL normal saline (R group), with 10 mg dexamethasone in 2 mL (RS group) or 1 µg/kg dexmedetomidine in 2 mL (RM group), or with 1 µg/kg dexmedetomidine and 10 mg dexamethasone in 2 mL (RSM group) administrated perineurally. The INB was performed by the surgeon under thoracoscopic direct vision; a total of six intercostal spaces were involved, each with an injection of 5 mL. The primary outcome was the duration of analgesia. Secondary outcomes included total postoperative fentanyl consumption, visual analog scale pain score and safety assessment (adverse effects).ResultsThe duration of analgesia in RSM (824.2±105.1 min) was longer than that in RS (611.5±133.0 min), RM (602.5±108.5 min) and R (440.0±109.6 min) (p<0.001). Total postoperative fentanyl consumption was lower in RSM (106.0±84.0 µg) compared with RS (243.0±175.2 µg), RM (237.0±98.7 µg) and R (369.0±134.2 µg) (p<0.001). No significant difference was observed in the incidences of adverse effects between the four groups.ConclusionThe addition of combined perineural dexmedetomidine and dexamethasone to ropivacaine for INB seemed to be an attractive method for prolonged analgesia with almost no adverse effects.Trial registration numberChiCTR-IOR-17012183.

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Section: Discussionmentioning

confidence: 99%

Dexamethasone and dexmedetomidine as adjuvants to local anesthetic mixture in intercostal nerve block for thoracoscopic pneumonectomy: a prospective randomized study

Zhang

Liu

Jing-ming

et al. 2019

Reg Anesth Pain Med

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“…Specifically, the patients who underwent the implantation with DS plus perioperative nonopioid analgesic administration and adjunctive TBL had a lower opioid consumption. While not evaluated in this manuscript, we are also currently in the process of exploring options to further prolong the duration of action of the TBL such as by using liposomal formulations or combining the local anesthetic with adjuvant dexmedetomidine . By prolonging the analgesic effect, one may expect to further mitigate the need for any postoperative narcotics in the future.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of subcutaneous implantable cardioverter‐defibrillator implantation with opioid sparing truncal plane blocks and deep sedation

Miller

Garg

Salter

et al. 2018

Cardiovasc electrophysiol

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“…Liposomes are traditionally used as a drug delivery system to increase the solubility of hydrophobic drugs, reduce their toxicity, prolong the circulation in the blood, or enable active targeting [51]. Alone or in combination with other excipients (hybrid systems), liposomes may provide a sustained release of the encapsulated drugs [52][53][54]. The versatile applicability of the system is depicted in Figure 3 and described in Table 3.…”

Section: Liposomal Systemsmentioning

confidence: 99%

Injectable Lipid-Based Depot Formulations: Where Do We Stand?

Rahnfeld

Luciani

2020

Pharmaceutics

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The remarkable number of new molecular entities approved per year as parenteral drugs, such as biologics and complex active pharmaceutical ingredients, calls for innovative and tunable drug delivery systems. Besides making these classes of drugs available in the body, injectable depot formulations offer the unique advantage in the parenteral world of reducing the number of required injections, thus increasing effectiveness as well as patient compliance. To date, a plethora of excipients has been proposed to formulate depot systems, and among those, lipids stand out due to their unique biocompatibility properties and safety profile. Looking at the several long-acting drug delivery systems based on lipids designed so far, a legitimate question may arise: How far away are we from an ideal depot formulation? Here, we review sustained release lipid-based platforms developed in the last 5 years, namely oil-based solutions, liposomal systems, in situ forming systems, solid particles, and implants, and we critically discuss the requirements for an ideal depot formulation with respect to the used excipients, biocompatibility, and the challenges presented by the manufacturing process. Finally, we delve into lights and shadows originating from the current setups of in vitro release assays developed with the aim of assessing the translational potential of depot injectables.

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Prolonged Duration Local Anesthesia Using Liposomal Bupivacaine Combined With Liposomal Dexamethasone and Dexmedetomidine

Abstract: Codelivery of Lipo-DexP and Lipo-DMED enhanced the efficacy of Lipo-Bup. This benefit was also seen with codelivery of both adjuvant molecules in the unencapsulated state, but with marked systemic toxicity.

Cited by 34 publications

References 32 publications

Dexamethasone and dexmedetomidine as adjuvants to local anesthetic mixture in intercostal nerve block for thoracoscopic pneumonectomy: a prospective randomized study

Dexamethasone and dexmedetomidine as adjuvants to local anesthetic mixture in intercostal nerve block for thoracoscopic pneumonectomy: a prospective randomized study

Feasibility of subcutaneous implantable cardioverter‐defibrillator implantation with opioid sparing truncal plane blocks and deep sedation

Injectable Lipid-Based Depot Formulations: Where Do We Stand?

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