An extended release local anaesthetic: potential for future use in veterinary surgical patients?

Abstract

One of the most effective means of preventing the transduction and transmission of acute and perioperative pain is through the use of local anaesthetics. However, local anaesthetics currently available have a relatively short duration of action. Although there are several tools available to treat perioperative pain in companion animals, overall, there is an unmet need for products that can be administered in the clinic, and provide pain relief for the crucial first few days following surgery in the home environment. Specifically, in relation to local anaesthetics, there is a clear unmet need for a long‐acting local anaesthetic that can be added to the multimodal analgesic protocol to provide pain relief to patients in the home environment or during extended hospitalization. Bupivacaine liposomal injectable suspension recently became available for use in humans, and has proven efficacious and safe. This paper will review the use of local anaesthetics, particularly bupivacaine, in dogs and cats, and introduce a new formulation of prolonged release bupivacaine that is in development for dogs and cats.

Sterility and concentration of liposomal bupivacaine single‐use vial when used in a multiple‐dose manner

“…Bupivacaine dissociates slowly from these channels, allowing for a longer duration of action compared with other local analgesics. Although the provision of analgesia is slightly longer than that of other local analgesics, this activity is limited to up to 8 hours of duration . The multivesicular liposomal formulation encapsulates bupivacaine in a lipid bilayer, with approximately 8% of the 13.3 mg/mL bupivacaine being considered “free” or unencapsulated.…”

Preliminary Evaluation of Sustained-release Compared with Conventional Formulations of Meloxicam in Sheep (Ovis aries)

“…3,6,13,19,21,32,39 Previous studies in biomedical sheep have demonstrated that SR buprenorphine reaches steady plasma concentrations and provides continuous analgesia against thermal nociception for at least 72 h. 39 In addition, liposomal bupivacaine has been evaluated as a SR local analgesic product for the prevention of transduction and transmission of acute and perioperative pain lasting 4 d in a rat model 19 and as long as 72 h in dogs. 22 The NSAID meloxicam belongs to the enolic acid class and has antiinflammatory, analgesic, and antipyretic properties. 33 Meloxicam has been formulated as a SR product in a fully biodegradable liquid polymer matrix that-according to the manufacturer-releases and provides therapeutic blood levels for as long as 72 h after a single subcutaneous injection in mice and rats.…”

The effect of extracorporeal shockwave on liposomal bupivacaine in a tibial plateau leveling osteotomy model

“…Surgical procedures are associated with perioperative and postoperative pain, and veterinary medicine has embraced a multimodal approach to pain management. [1][2][3][4] Systemic analgesics are the mainstay of current perioperative pain management protocols, but all have some adverse event risks including dysphoria, bradypnea, and hyperalgesia. 5,6 Local and regional anesthetics are frequently used to compliment systemic analgesia and act through blocking transmission of nociceptive signals.…”

“…5,6 Local and regional anesthetics are frequently used to compliment systemic analgesia and act through blocking transmission of nociceptive signals. 3,7,8 Historically, local and regional anesthetics were administered in the preoperative or immediate postoperative period, but their short duration of action limited…”

“…3 Bupivacaine HCl, the longest-acting of these anesthetics, has an efficacy duration of 6 to 8 hours. 3,9,10 In 2016, a bupivacaine liposome injectable suspension (Nocita; Elanco Animal Health, Greenfield, Indiana) became commercially available for veterinary use. This bupivacaine suspension uses DepoFoam technology to safely provide local analgesia for up to 72 hours after surgical procedures in dogs and cats.…”