Bupivacaine liposomal 266mg/20ml prolonged-release dispersion for injection vials

BACKGROUND AND OBJECTIVE: Thoracic epidural analgesia has traditionally been used for pain management after open abdominal surgery, but its use has declined. The quest for efficient alternatives has resulted in the increasing use of regional techniques. These can be applied as single-shot or continuous blocks using catheters. Long-acting liposomal bupivacaine could preclude the use of catheters. This review aimed to evaluate the effectiveness of ultrasound-guided abdominal wall blocks with liposomal bupivacaine for open abdominal surgery. DATABASES AND DATA TREATMENT: Medline ALL, Embase, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, and Google Scholar were systematically searched. Screening, data extraction, and quality assessment were done by two independent researchers. Inclusion criteria were (1) liposomal bupivacaine in ultrasound-guided abdominal wall blocks for open abdominal surgery, (2) outcome of pain and/or opioid consumption, (3) patients >18 years, and (4) reports published in English. RESULTS: Of the 1277 studies found, 22 met the inclusion criteria. The Cochrane Risk of Bias (Version 2) tool was used to assess randomized controlled trials. Studies were grouped for clarity. Transversus abdominis plane (TAP) blocks were mostly investigated. Data were heterogenic regarding types of surgery, approach to block placement, anesthetic solution injected, and use of intrathecal morphine (ITM). CONCLUSIONS: Patients undergoing cesarean section with neuraxial anesthesia and intrathecal morphine benefit from TAP blocks with liposomal bupivacaine, demonstrating reduced opioid consumption and comparable pain. Evidence for other open abdominal surgeries was inconclusive. Abdominal wall blocks with liposomal bupivacaine could be a viable alternative when epidural analgesia is contraindicated.

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BACKGROUND: The analgesic effect of adding liposomal bupivacaine to standard bupivacaine in supraclavicular brachial plexus block is not known. The authors hypothesized that addition of liposomal bupivacaine would reduce acute postoperative pain compared to standard bupivacaine alone. METHODS: A randomized controlled trial was conducted. Patients and outcome assessors were blinded. Eighty patients undergoing distal radial fracture fixation during regional anesthesia with supraclavicular brachial plexus block were randomized into two groups. The liposomal bupivacaine group received 10 ml 0.5% plain bupivacaine immediately followed by 10 ml 1.33% liposomal bupivacaine (n = 40). The standard bupivacaine group received 20 ml 0.5% plain bupivacaine (n = 40). The primary outcome was weighted area under curve (AUC) numerical rating scale pain score at rest during the first 48 h after surgery. Secondary outcomes included weighted AUC scores for pain with movement, overall benefit with analgesia score, and other functional scores. RESULTS: For the primary outcome, the liposomal bupivacaine group was associated with statistically significantly lower weighted AUC pain score at rest (0.6 vs. 1.4; P < 0.001) in the first 48 h. Of the secondary outcomes, no difference between treatment groups reached statistical significance with the exception of weighted AUC score for pain with movement (2.3 vs. 3.7; adjusted P < 0.001) and overall benefit with analgesia score (1.1 vs. 1.7; adjusted P = 0.020) in the first 48 h, as well as numerical rating scale pain score at rest (0.5 vs. 1.9; adjusted P < 0.001) and with movement (2.7 vs. 4.9; adjusted P < 0.001) on postoperative day 1. Differences in numerical rating scale pain scores on postoperative days 2, 3, and 4 did not reach the level of statistical significance. There were no statistically significant differences in sensory function. CONCLUSIONS: Liposomal bupivacaine given via supraclavicular brachial plexus block reduced pain at rest in the early postoperative period.

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Background: The optimal analgesic regimen after video-assisted thoracoscopic surgery (VATS) is unclear. We aimed to examine whether ultrasound-guided serratus anterior plane block (SAPB) with liposomal bupivacaine could provide continuous and effective analgesic effects for lung cancer patients undergoing VATS. Methods: A total of 64 patients were randomly allocated to receive either the liposomal bupivacaine (LB group) or the ropivacaine (RO group). The primary outcome was pain score at rest and on movement in the first three days after surgery. The secondary outcomes included intraoperative remifentanil consumption, perioperative consumption of sufentanil and flurbiprofen axetil, time to extubation, time to first bowel movement, time to first flatus, incidence of postoperative nausea and vomiting (PONV), length of intensive care unit (ICU) stay, length of hospital stay, hospitalization costs, and early recovery quality as assessed by QoR-15 score. Results: The LB group had significantly lower pain scores at rest and on movement at 12h, 24h, 36h, 48h, and 72h after surgery, and lower pain scores on movement at 8h after surgery, when compared with the RO group. Perioperative sufentanil consumption and postoperative flurbiprofen axetil consumption were significantly reduced in the LB group than in the RO group. In addition, compared with the RO group, the LB group had earlier first flatus, mobilization, and urinary catheter removal, shorter ICU stay, lower incidence of PONV, and lower hospitalization costs. The QoR-15 scores in the first three days after surgery were significantly higher in the LB group than in the RO group. There were no statistically significant differences between the two groups regarding time to extubation, intraoperative remifentanil consumption, and length of hospital stay. Conclusion: Ultrasound-guided SAPB with liposomal bupivacaine was effective in relieving postoperative pain for three days after surgery in patients undergoing VATS.

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BACKGROUND: Patients often suffer from moderate to severe acute postoperative pain after liver resection, and the use of liposomal bupivacaine (LB) for pain management is widespread. However, no studies have demonstrated the effect of postoperative analgesia with LB administered via a thoracic paravertebral block (TPVB). The aim of this study was to evaluate the effects of TPVB-administered LB and standard bupivacaine (SB) on opioid sparing and postoperative recovery following liver resection METHODS: In this randomized, prospective, single-blind study, 96 patients were randomly (1:1) assigned to two groups. The primary outcome was cumulative opioid consumption over the first 72 h. the secondary outcomes were the time to first opioid use after surgery, plasma bupivacaine concentration, quality of recovery 40 (QoR-40) score area under the curve (AUC) from 24 to 72 h, pain visual analog scale (VAS) score AUC from 6 h to 3 months, postoperative plasma inflammatory factor levels, and sleep quality at 3 months after surgery RESULTS: Ninety-three patients (age (SD), 59.8 (10.5) years; 74 males, 79.6 %) were included in the final analysis. The cumulative opioid consumption was lower in the LB group 63.0 (IQR: 10.5, 90.0) than in the SB group of patients receiving the (72.0 (IQR: 27.0, 135.0) mg oral morphine equivalent (p = 0.041). Compared to those in the SB group, the time to first opioid use was longer, and the plasma bupivacaine and TNF-α levels were greater postoperatively in the LB group. There was no difference in other outcomes between the two groups, and there were no adverse events in this study CONCLUSION: TPVB-administered LB reduced total opioid consumption postoperatively in patients undergoing hepatectomy in the first 72 h.

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