A Double-Blind, Randomized, Active-Controlled Study for Post-Hemorrhoidectomy Pain Management with Liposome Bupivacaine, a Novel Local Analgesic Formulation

Abstract

This randomized, active-controlled study evaluated the extent and duration of analgesia after administration of liposome bupivacaine (LB), a novel formulation of bupivacaine, compared with bupivacaine HCl given via local infiltration in excisional hemorrhoidectomy. One hundred patients were randomly assigned to receive a single dose of bupivacaine HCl 75 mg (0.25% with 1:200,000 epinephrine) or LB 66, 199, or 266 mg upon completion of hemorrhoidectomy. Postoperative pain intensity was assessed using a numeric rating scale at rest to calculate a cumulative pain score (area under the curve). Cumulative pain scores were significantly lower with LB at each study dose ( P < 0.05) compared with bupivacaine HCl 72 hours after surgery. Post hoc analysis showed that mean total postoperative opioid consumption was statistically significantly lower for the LB 266-mg group compared with the bupivacaine HCl group during the 12- to 72-hour postoperative period ( P = 0.019). Median time to first opioid use was 19 hours for LB 266 mg versus 8 hours for bupivacaine HCl ( P = 0.005). Incidence of opioid-related adverse events was 4 per cent for LB 266 mg compared with 35 per cent for bupivacaine HCl ( P = 0.007). Local infiltration with LB resulted in significantly reduced postsurgical pain compared with bupivacaine HCl in patients after hemorrhoidectomy surgery.

Liposomal Bupivacaine Injection Technique in Total Knee Arthroplasty

“…In recent years, there has been fast-paced interest and adoption of liposomal bupivacaine for pain control after TKA, often based on professional opinion and experience rather than research-based evidence. 6,16,18 The efficacy of liposomal bupivacaine has been demonstrated for hemor-rhoidectomy, bilateral cosmetic submuscular mammoplasty augmentation, bunionectomy, and open segmental colectomy with anastomosis [19][20][21][22][23] ; however, its effectiveness in TKA has been equivocal (2014 AAOS Annual Meeting Proceedings, Paper 675, Liposomal Bupivacaine: The First 1,000 Cases in a New Era; 2014 AAOS Annual Meeting Proceedings, Poster P124, Comparison of Infiltration with Long-Acting Bupivacaine to a Femoral Nerve Catheter for Total Knee Replacement; 2015 AAOS Annual Meeting Proceedings, Paper 752, Does Extended-Release Liposomal Bupivacaine Better Control Postoperative Knee Pain than Bupivacaine?). 17,[24][25][26] It has been reported that using a smaller 20-gauge needle rather than a larger 18-gauge needle and administering small amounts of drug in many locations makes a difference in the effectiveness of liposomal bupivacaine for pain following TKA.…”

Update on emerging regional techniques and novel local anesthetics in ambulatory anesthesia

“…Mean number of narcotic pills consumed was 1.4 and 1.8 on POD 1 and 2, respectively, compared to 3.6 on both days in the control group Haas et al, 2012 90 Hemorrhoidectomy Liposomal bupivacaine compared to bupivacaine HCl…”

A Review of Postoperative Analgesia for Breast Cancer Surgery

“…As there is a lack of evidence from RCTs supporting liposomal bupivacaine as significantly advantageous to bupivacaine HCl, and as the cost of the newer formulation is drastically higher than the original, further studies are needed before commonplace use of the liposomal formulation is advised. Of note, of the nine RCTs that compared the two bupivacaine formulations for various surgeries including breast surgery, the only one that reported improved analgesia involved hemorrhoidectomy [84][85][86][87].…”