Bupivacaine 12.5mg/5ml (0.25%) / Adrenaline (base) 25micrograms/5ml (1 in 200,000) solution for injection ampoules

General anaesthesia (GA) as a pharmacological behaviour management strategy may be indicated for dental extractions in children unable to cooperate in the dental chair. Pain is the most common postoperative complication in children following dental GA. There is conflicting evidence available on the efficacy of local anaesthetic (LA) agents for postoperative pain management following dental extraction. Therefore, this review aimed to evaluate the efficacy of different pharmacological analgesic techniques on postoperative pain following dental extractions under GA in children. A search of PubMed, Embase, Scopus and CINAHL was conducted on 17/10/2023 to identify studies eligible for inclusion in this review. Two independent reviewers performed search screening, data extraction and critical appraisal. Results were narratively described due to heterogeneity of pain assessment tools and management strategies. The search yielded 8742 results, of which 15 studies were included. Methods of pain assessment varied greatly across included studies, with 14 different pain scales used across the 15 studies. Included studies suggest preoperative oral paracetamol and oral ibuprofen as well as postoperative topical bupivacaine lowered pain scores. This review underscores the challenges in reliably assessing pain in children and highlights the necessity for age-specific validated pain assessment tools.

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BackgroundAutologous breast reconstruction using abdominally based flaps is common post-mastectomy, but donor-site pain often leads to prolonged opioid use. The transversus abdominis plane (TAP) block is a common regional anesthesia technique, with bupivacaine as the standard anesthetic. Liposomal bupivacaine (LB), a prolonged-release formulation, aims to extend pain relief and reduce opioid consumption, though its efficacy remains debated.ObjectiveThis systematic review and meta-analysis compared LB versus plain bupivacaine (PB) in TAP blocks for autologous breast reconstruction, focusing on opioid consumption, pain scores, and hospital stay.MethodsA systematic search identified randomized controlled trials and observational studies comparing LB (with or without PB) to PB in TAP blocks. Data were pooled using a random-effects model (I2 ≥ 25%) or fixed-effects model (I2 ResultsSix studies (429 patients) met inclusion criteria. LB was associated with significant reduction in opioid consumption on postoperative days (POD) 1 (MD = -4.99 mg; 95% CI: [-8.42; -1.56], p 2 = 0%) and POD 2 (MD = -3.35 mg; 95% CI: [-5.74; -0.96], p 2 = 0%). Pain scores were significantly lower on POD 2 and POD 3. No difference in hospital stay was found (MD = -0.17; 95% CI: [-0.52; 0.18], p = 0.34, I2 = 83.1%).ConclusionLB reduced opioid consumption during the first 48 h postoperatively and modestly improved pain control on POD 2 and POD 3, but did not shorten hospital stay. Further large-scale RCTs are needed to validate its benefits.

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BackgroundCombining lidocaine with bupivacaine in brachial plexus blocks seeks to blend rapid onset with extended duration; yet, clinical advantages are uncertain. This systematic review assesses their efficacy against bupivacaine alone in ultrasound-guided brachial plexus blocks.MethodsA systematic search of PubMed, EMBASE, and Cochrane databases was conducted in May 2025. Randomized controlled trials (RCTs) comparing lidocaine-bupivacaine mixtures with bupivacaine alone in ultrasound-guided brachial plexus blocks were included. The primary outcome was sensory block onset time. Secondary outcomes included motor block onset time, sensory and motor block durations, and conversion to general anesthesia. Data were analyzed using a random-effects model, with heterogeneity assessed via I² statistics.ResultsOf 1,490 identified articles, 7 RCTs (358 patients) met the inclusion criteria. No significant difference was found in sensory block onset time (mean difference [MD] -1.81 min, 95% confidence interval [CI] -3.92 to 0.29; P = 0.09; I² = 98%) or motor block onset time (MD 0.02 min, 95% CI -2.34 to 2.39; P = 0.99; I² = 95%) between groups. The mixture reduced sensory (MD -172.88 min, 95% CI -215.18 to -130.59; PConclusionsNo clinical benefit was observed from combining lidocaine with bupivacaine, as there was no improvement in block onset times and a reduction in block durations. Given the very low certainty of evidence, these findings should be interpreted with caution, and further high-quality RCTs are needed.

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Postoperative pain is a significant challenge that can delay early mobilization and prolong hospitalization after total knee arthroplasty (TKA). Effective pain management is critical to promote rehabilitation, reduce opioid consumption, and improve long-term patient outcomes. Bupivacaine and ropivacaine are widely utilized local anesthetics administered by way of peripheral nerve blocks, periarticular injections, and epidural anesthesia to help manage postoperative pain. This systematic review and meta-analysis aimed to compare postoperative pain levels after administering bupivacaine or ropivacaine via peripheral nerve blocks or periarticular injections. Secondary outcomes included length of stay (LOS), rescue analgesia, and motor blockade. Subgroup analysis was performed to differentiate between drug administration by way of peripheral nerve blocks and periarticular injections. A total of nine studies and 656 patients were included. There was no difference in pain levels at 6 hours (MD = 0.12, 95% CI, -0.41 to 0.65, P = 0.66), 12 hours (MD = - 0.01, 95% CI, -0.62 to 0.61, P = 0.98), and 24 hours postoperative (MD = 0.17; 95% CI, -0.27 to 0.61, P = 0.46) between peripheral nerve blocks and periarticular injections of bupivacaine and ropivacaine. At 72 hours postoperative, ropivacaine decreased pain levels when administered through peripheral nerve block only (MD = 0.82, 95% CI, 0.55 to 1.09, P = 0.002). There were no differences in LOS or rescue analgesia, but bupivacaine provided a greater degree of motor nerve blockade (MD = 0.18, 95% CI, 0.01 to 0.35, P = 0.04) assessed by the classical Bromage scale. The findings suggest that bupivacaine and ropivacaine provide comparable analgesic efficacy for postoperative pain control following TKA, indicating that the drug of choice may be due to secondary factors, including cost, availability, or provider preference.

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ObjectiveTo evaluate the analgesic efficacy and safety of local anesthetic infiltration in the tonsillar fossa using ropivacaine compared to bupivacaine in pediatric patients undergoing tonsillectomy.Data sourcesCENTRAL, PubMed, Web of Science, Scopus, and Google Scholar.Review methodsEligible randomized controlled trials (RCTs) were evaluated for risk of bias using Cochrane's Risk of Bias Tool (RoB-2). The primary outcome was postoperative pain within the first 24 hours following tonsillectomy. Secondary outcomes included the time to first analgesic requirement and complication rates (ie, bleeding, airway obstruction, local anesthetic toxicity, and nausea). Data were synthesized using the standardized mean difference (SMD) for continuous outcomes and risk ratio (RR) for dichotomous outcomes, both reported with 95% confidence intervals (CI).ResultsSeven RCTs with a total of 375 patients were analyzed. Regarding posttonsillectomy pain scores, there was no significant difference between ropivacaine and bupivacaine at 1 hour (SMD = -0.01, 95% confidence interval [CI] [-0.36, 0.34]), 2 hours (SMD = 0.03, 95% CI [-0.45, 0.51]), 4 hours (SMD = -0.17, 95% CI [-0.39, 0.06]), 6-8 hours (SMD = 0.04, 95% CI [-0.38, 0.46]), and 12 hours (SMD = -0.23, 95% CI [-0.62, 0.15]). However, at 24 hours, ropivacaine demonstrated a superior effect compared to bupivacaine (SMD = -0.23, 95% CI [-0.43, -0.03]). There was no significant difference between ropivacaine and bupivacaine in terms of time to first analgesia and complication rates (P > .05).ConclusionThis meta-analysis demonstrated that ropivacaine and bupivacaine offer comparable clinical analgesic efficacy and safety profiles in pediatric patients undergoing tonsillectomy.

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BackgroundThe quality of recovery (QoR) is a multidimensional concept used to evaluate the restoration of physical and psychological functions after surgery. It is a key measure for assessing surgical efficacy, anesthetic modalities, and the effectiveness of perioperative interventions. Liposomal bupivacaine (LB), a long-acting local anesthetic recently introduced, is characterized by its sustained-release profile and prolonged analgesic effect. However, empirical findings regarding the impact of LB on the quality of postoperative recovery remain inconclusive.MethodsOn 5 March 2025, we conducted a systematic search of the PubMed, Embase, Web of Science, Cochrane Library, Scopus, CNKI, and VIP databases to identify randomized controlled trials (RCTs) assessing the efficacy of LB in postoperative recovery. Eligible studies compared postoperative recovery outcomes between patients receiving LB and those in control groups who did not receive LB. The primary outcome of interest was the QoR score measured 72 h after surgery. Secondary outcomes included QoR scores at 24 and 48 h after surgery; pain scores at rest at 24, 48, and 72 h after surgery; incidence of postoperative nausea and vomiting (PONV); cumulative morphine-equivalent opioid consumption within 72 h after surgery; and patient satisfaction.ResultsThis meta-analysis included 11 RCTs comprising a total of 1,357 patients. The findings indicate that the LB group showed a statistically significant improvement in overall QoR scores 72 h after surgery [standardized mean difference (SMD): 0.52; 95% confidence interval (CI): 0.20, 0.85; P = 0.00]. Furthermore, LB use was associated with significantly reduced pain scores at 24, 48, and 72 h after surgery. The LB group also exhibited lower cumulative morphine-equivalent opioid consumption within 72 h after surgery, a reduced incidence of PONV, and significantly higher patient satisfaction scores.ConclusionThe use of LB was associated with improved QoR scores within 72 h after surgery, a reduced incidence of PONV, and decreased opioid consumption. These findings suggest that LB not only improves overall postoperative recovery but also mitigates associated adverse effects, thereby contributing to improved patient satisfaction and a more streamlined recovery trajectory. Nevertheless, further research is needed to assess its long-term efficacy and broader clinical applicability.Systematic review registration[https://www.crd.york.ac.uk/prospero/], identifier [CRD420251003585].

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INTRODUCTION: Recent evidence has questioned the advantage of local anesthetic (LA) combinations. This study tested the hypothesis that mixing rapid-onset (lidocaine) and long-duration (bupivacaine) LA would provide faster onset of complete conduction blockade (CCB) compared with bupivacaine alone and longer duration of analgesia compared with lidocaine alone during low-volume (20 mL) ultrasound-guided (USG) supraclavicular brachial plexus block (SCBPB). METHODS: : 20 mL of equi-volume mixture of both drugs. Sensory and motor blockade was recorded on a three point sensory and motor assessment scale at 10 min intervals for up to 40 min and the total composite score (TCS) at each time point was determined. The duration of analgesia was also noted. RESULTS: The mean time to CCB of group LB (16±7 min) was comparable (p>0.05) with group L (14±6 min) and group B (21±8 min) in patients who were attained CCB. However, the proportion of patients attaining complete conduction block (TCS=16/16) was significantly lower (p=0.0001) in group B (48%) when compared with group L (95%) and group LB (95%) at the end of 40 min. The median (IQR) duration of postoperative analgesia was longest in group B; 12.2 (12-14.5) hours, followed by group LB 8.3 (7-11) hours and 4 (2.7-4.5) hours in group L. CONCLUSION: At 20 mL LA volume, equal mixture of lidocaine and bupivacaine provided significantly faster onset of CCB compared with bupivacaine alone and longer duration of postoperative analgesia compared with lidocaine alone but shorter than bupivacaine alone during low-volume USG-SCBPB. TRIAL REGISTRATION NUMBER: CTRI/2020/11/029359.

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