Bupivacaine Liposomal versus Bupivacaine: Comparative Review

Abstract

Bupivacaine liposomal injection was recently approved by the US Food and Drug Administration (FDA) as a local anesthetic for use in management of postsurgical pain in adults. When compared to placebo, bupivacaine liposomal decreases postoperative pain and opioid use. This review examines the efficacy of bupivacaine liposomal when compared to conventional bupivacaine ± epinephrine using published and unpublished data provided to the FDA by the manufacturer.

HTX-011 reduced pain intensity and opioid consumption versus bupivacaine HCl in herniorrhaphy: results from the phase 3 EPOCH 2 study

“…Most notably, a prespecified sensitivity analysis without adjustment of opioid analgesic effect confirmed the robustness of the primary analysis. Therefore, even as the control groups benefited from the pain-reducing effects of significantly greater opioid use, subjects who received HTX-011 (who utilized less opioids as well as less acetaminophen) still experienced significantly less pain through 72 h. To our knowledge, no other extended release local anesthetic, including liposomal bupivacaine, has shown significant analgesic activity in the second or third day after a single administration with or without adjustment for opioid use [6][7][8].…”

“…Standard clinical practice for managing postoperative pain includes preoperative and intraoperative use of local infiltration and/or anesthetic field blocks with local anesthetics such as bupivacaine [1], which is the most widely used local anesthetic for implementing postoperative analgesia. Unfortunately, bupivacaine has limited efficacy beyond 6-12 h, which frequently results in the overreliance on opioids for postoperative pain management [6][7][8]. Although opioids can provide effective analgesia for moderate to severe pain, higher opioid doses are associated with an increased risk of adverse drug effects (including postoperative nausea and vomiting, respiratory depression, sedation, and delirium/confusion) [9,10].…”

Response to Hamid et al., ‘The role of laparoscopic‐guided transversus abdominis plane block in laparoscopic colorectal surgery’

“…Despite the obvious logic of utilizing liposomal bupivacaine, the evidence is still not robust enough to consider its routine use, particularly when the additional cost implications associated with its use in clinical practice are considered. The results of a comparative study by Noviasky et al [6] did not demonstrate any benefit of liposomal bupivacaine over standard bupivacaine in terms of either pain or opioid consumption; furthermore, liposomal bupivacaine was not (and still is not) available in our centre.…”

Opiate‐Free Pain Therapy Using Carbamazepine‐Loaded Microparticles Provides Up to 2 Weeks of Pain Relief in a Neuropathic Pain Model

“…Though these systems demonstrated the ability to sustain local analgesia, the high doses of bupivacaine required to achieve efficacy were observed to impart local neurotoxicity, myotoxicity, and the potential for partial to complete motor blockade . Additionally, they may not provide a clinically significant reduction in opioid use or better pain outcomes compared to the standard of care …”

“…[20][21][22] Additionally, they may not provide a clinically significant reduction in opioid use or better pain outcomes compared to the standard of care. 23,24 Alternatively, anticonvulsants have demonstrated clinical efficacy in the management of acute and chronic indications of neuropathic pain, including post-herpetic neuralgia, fibromyalgia, diabetic neuropathy, and postoperative pain. 12,13,[25][26][27][28][29] Local anesthetics provide nonselective blockade of the "open" state of the voltagegated sodium channel affecting both sensory and motor neurons.…”