Systematic Review of Liposomal Bupivacaine (Exparel) for Postoperative Analgesia

Vyas, Krishna S.; Rajendran, Sibi; Morrison, Shane D.; Shakir, Afaaf; Mardini, Samir; Lemaine, Valérie; Nahabedian, Maurice Y.; Baker, Stephen B.; Rinker, Brian; Vásconez, Henry C.

doi:10.1097/prs.0000000000002547

Cited by 117 publications

(72 citation statements)

References 32 publications

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“…Vyas et al. [ 27 ] systematically reviewed the efficacy of LB in plastic surgery and found comparable or better favorability than control groups across multiple outcomes. Another meta-analysis [ 28 ] evaluating the role of local infiltration of LB after total hip arthroplasty found better pain control at 24 h and decreased length of stay.…”

Section: Discussionmentioning

confidence: 99%

Systematic review and meta-analysis of the efficacy of liposomal bupivacaine in colorectal resections

Raman

Lin

Krishnan

2018

Journal of Drug Assessment

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Objective: The objective of the study was to systematically investigate the outcomes of Liposomal Bupivacaine following major colorectal resections.Patients and methods: We conducted a comprehensive literature search of PubMed, Medline, Google scholar, Cochrane Central Registry and clinical trials.gov databases through May 2017 for studies published regarding liposomal bupivacaine. Studies were filtered based on relevance to perioperative analgesia in colorectal resections. Data comparing type of study, techniques of resection, mode of administration of liposomal bupivacaine, details of control group, outcomes were collected.Results: A total of 1008 patients from seven studies were included in this systematic review and meta-analysis. The studies were mostly retrospective or prospective cohort studies with one randomized controlled trial (RCT). Meta-analysis showed that liposomal bupivacaine was associated with decreased length of stay, standard mean difference in days (SMD) − 0.34, (95% confidence intervals [CI] − 0.56, −0.13, p = .001) and decreased IV opioid use (expressed as intravenous morphine equivalent in milligrams) in the first 48–72 h, SMD −0.49 (95% CI −0.69, −0.28, p < .00001). Pain scores were also significantly low in patients who received liposomal bupivacaine, SMD −0.56 (95% CI −1.07, −0.06, p = .03]. There was no significant difference in hospitalization costs between the two groups.Conclusions: Use of liposomal bupivacaine is associated with decreased IV opioid use, length of stay and lower pain scores. However, our data needs to be interpreted cautiously given the relative paucity of randomized controlled trials.

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Section: Discussionmentioning

confidence: 99%

Systematic review and meta-analysis of the efficacy of liposomal bupivacaine in colorectal resections

Raman

Lin

Krishnan

2018

Journal of Drug Assessment

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“…We recently demonstrated in a prospective, randomized, control trial that a liposomal bupivacaine TAP block in patients undergoing delayed unilateral deep inferior epigastric perforator (DIEP) reconstruction resulted in decreased postoperative narcotic utilization as compared to a bupivacaine TAP block, pain cathether or local infiltration [1][2][3][4][5][6][7][8]. We were able to demonstrate also, via a retrospective chart review, that these findings were upheld in patients who underwent bilateral delayed reconstruction [9].…”

Section: Introductionmentioning

confidence: 92%

Comparison of Liposomal Bupivacaine for Pain Management after Immediate and Delayed Deep Inferior Epigastric Perforator Free Flap Reconstruction

Knackstedt¹,

Gatherwright²,

Ghaznavi³

et al. 2018

J Aesthet Reconstr Surg

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Patient analgesia can be addressed pre, intra and postoperatively. The utilization of local anesthetics administered intra-operatively is limited by the medication's short duration of action. However, an intraoperative transversus abdominis plane (TAP) block can be utilized to anesthetize the T6-L1 intercostal nerves that supply the anterior abdominal wall. This provides analgesia to the abdominal wall, which has been identified as the largest source of post-operative pain following abdominally-based autologous tissue breast reconstruction.

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“…Alternatively, several LA carriers with extended release have been developed, among which liposomes have been shown to be the least toxic ( Weiniger et al, 2012 ). A multilamellar liposome formulation of bupivacaine (Exparel) has so far failed to show PNB of major nerves ( Hadzic et al, 2016 ) and remains of limited indication ( Vyas et al, 2016 ). Further experimental work is required to understand the in vivo effects of liposomal LA nanomedicines.…”

Section: Introductionmentioning

confidence: 99%

An in Vivo Mouse Model to Investigate the Effect of Local Anesthetic Nanomedicines on Axonal Conduction and Excitability

et al. 2018

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Peripheral nerve blocks (PNBs) using local anesthetic (LA) are superior to systemic analgesia for management of post-operative pain. An insufficiently short PNB duration following single-shot LA can be optimized by development of extended release formulations among which liposomes have been shown to be the least toxic. In vivo rodent models for PNB have focused primarily on assessing behavioral responses following LA. In a previous study in human volunteers, we found that it is feasible to monitor the effect of LA in vivo by combining conventional conduction studies with nerve excitability studies. Here, we aimed to develop a mouse model where the same neurophysiological techniques can be used to investigate liposomal formulations of LA in vivo. To challenge the validity of the model, we tested the motor PNB following an unilamellar liposomal formulation, filled with the intermediate-duration LA lidocaine. Experiments were carried out in adult transgenic mice with fluorescent axons and with fluorescent tagged liposomes to allow in vivo imaging by probe-based confocal laser endomicroscopy. Recovery of conduction following LA injection at the ankle was monitored by stimulation of the tibial nerve fibers at the sciatic notch and recording of the plantar compound motor action potential (CMAP). We detected a delayed recovery in CMAP amplitude following liposomal lidocaine, without detrimental systemic effects. Furthermore, CMAP threshold-tracking studies of the distal tibial nerve showed that the increased rheobase was associated with a sequence of excitability changes similar to those found following non-encapsulated lidocaine PNB in humans, further supporting the translational value of the model.

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Systematic Review of Liposomal Bupivacaine (Exparel) for Postoperative Analgesia

Abstract: Liposomal bupivacaine is a safe method for postoperative pain control in the setting of plastic surgery and may represent an alternative to more invasive pain management systems such as patient-controlled analgesia, epidurals, peripheral nerve catheters, or intravenous narcotics.

Cited by 117 publications

References 32 publications

Systematic review and meta-analysis of the efficacy of liposomal bupivacaine in colorectal resections

Systematic review and meta-analysis of the efficacy of liposomal bupivacaine in colorectal resections

Comparison of Liposomal Bupivacaine for Pain Management after Immediate and Delayed Deep Inferior Epigastric Perforator Free Flap Reconstruction

An in Vivo Mouse Model to Investigate the Effect of Local Anesthetic Nanomedicines on Axonal Conduction and Excitability

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