Clinical Efficacy of Liposomal Bupivacaine

Abildgaard, Jeffrey T.; Chung, Andrew S.; Tokish, John M.; Hattrup, Steven J.

doi:10.2106/jbjs.rvw.18.00192

Cited by 27 publications

(16 citation statements)

References 38 publications

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“…It is remarkable that externally applied CNCB-2 inhibits sodium channels more potently than bupivacaine, one of the most potent local anesthetics. Recent work has introduced preparations of bupivacaine delivered in liposomes designed for slow release and longer-lasting effects when applied to wounds during surgery (Abildgaard et al, 2019). The intrinsically higher potency and expected slower diffusion away from the site of application – as reflected in the long durations of action we saw in the mouse paw incision model - may make cationic CNCB-2 ideal for such applications even without packaging in liposomes, and its much greater solubility in aqueous solutions may facilitate its use in various other slow-release technologies for even longer-lasting local pain inhibition.…”

Section: Discussionmentioning

confidence: 99%

Novel charged sodium and calcium channel inhibitor active against neurogenic inflammation

Lee

Talbot

et al. 2019

eLife

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Voltage-dependent sodium and calcium channels in pain-initiating nociceptor neurons are attractive targets for new analgesics. We made a permanently charged cationic derivative of an N-type calcium channel-inhibitor. Unlike cationic derivatives of local anesthetic sodium channel blockers like QX-314, this cationic compound inhibited N-type calcium channels more effectively with extracellular than intracellular application. Surprisingly, the compound is also a highly effective sodium channel inhibitor when applied extracellularly, producing more potent inhibition than lidocaine or bupivacaine. The charged inhibitor produced potent and long-lasting analgesia in mouse models of incisional wound and inflammatory pain, inhibited release of the neuropeptide calcitonin gene-related peptide (CGRP) from dorsal root ganglion neurons, and reduced inflammation in a mouse model of allergic asthma, which has a strong neurogenic component. The results show that some cationic molecules applied extracellularly can powerfully inhibit both sodium channels and calcium channels, thereby blocking both nociceptor excitability and pro-inflammatory peptide release.

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Section: Discussionmentioning

confidence: 99%

Novel charged sodium and calcium channel inhibitor active against neurogenic inflammation

Lee

Talbot

et al. 2019

eLife

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“…As such, controlled-release local anesthetic formulations have also been developed [257][258][259]. Liposomal bupivacaine has not demonstrated clinically meaningful benefits to postoperative pain control or opioid reduction when compared to conventional local anesthetics in local wound infiltration, periarticular injection, or peripheral nerve blockade [249,[260][261][262][263][264][265][266][267][268][269][270][271][272][273][274][275]. Potential benefits and cost-effectiveness of extended-release local anesthetic formulations are likely to vary significantly depending on injection technique, site, and type of surgical procedure, so institutions should consider surgery-and patient-specific use of these agents.…”

Section: Regional and Local Anesthesiamentioning

confidence: 99%

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

et al. 2021

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Surgical procedures are key drivers of pain development and opioid utilization globally. Various organizations have generated guidance on postoperative pain management, enhanced recovery strategies, multimodal analgesic and anesthetic techniques, and postoperative opioid prescribing. Still, comprehensive integration of these recommendations into standard practice at the institutional level remains elusive, and persistent postoperative pain and opioid use pose significant societal burdens. The multitude of guidance publications, many different healthcare providers involved in executing them, evolution of surgical technique, and complexities of perioperative care transitions all represent challenges to process improvement. This review seeks to summarize and integrate key recommendations into a “roadmap” for institutional adoption of perioperative analgesic and opioid optimization strategies. We present a brief review of applicable statistics and definitions as impetus for prioritizing both analgesia and opioid exposure in surgical quality improvement. We then review recommended modalities at each phase of perioperative care. We showcase the value of interprofessional collaboration in implementing and sustaining perioperative performance measures related to pain management and analgesic exposure, including those from the patient perspective. Surgery centers across the globe should adopt an integrated, collaborative approach to the twin goals of optimal pain management and opioid stewardship across the care continuum.

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“…Finally, although liposomal bupivacaine has been touted as an effective strategy to prolong the duration of analgesia (up to 72 h) with single-injection PNB [71], current evidence fails to support its routine use. Superior analgesia and opioid-sparing compared to conventional long-acting local anesthetics has not been demonstrated to date [72,73], and no studies have examined if it reduces the incidence and magnitude of rebound pain.…”

Section: Local Anesthetic Adjuncts In Single-injection Pnbmentioning

confidence: 99%

Managing rebound pain after regional anesthesia

Muñoz-Leyva

Cubillos

Chin

2020

Korean J Anesthesiol

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Rebound pain after regional anesthesia can be defined as transient acute postoperative pain that ensues following resolution of sensory blockade, and is clinically significant, either with regard to the intensity of pain or the impact on psychological well-being, quality of recovery, and activities of daily living. Current evidence suggests that it represents an unmasking of the expected nociceptive response in the absence of adequate systemic analgesia, rather than an exaggerated hyperalgesic phenomenon induced by local anesthetic neural blockade. In the majority of patients, it does not appear to significantly impact cumulative postoperative opioid consumption, quality of recovery, or patient satisfaction, and is not associated with longer-term sequelae such as persistent post-surgical pain. Nevertheless, it must be considered whenever regional anesthesia is incorporated into perioperative management. Strategies to mitigate the impact of rebound pain include routine prescribing of a systemic multimodal analgesic regimen, as well as patient education on appropriate expectations regarding block offset and expected surgical pain, and timely initiation of analgesic medication. Prolonging the duration of action of regional anesthesia with continuous catheter techniques or local anesthetic adjuncts may also help alleviate rebound pain, although further research is required to confirm this.

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Clinical Efficacy of Liposomal Bupivacaine

Cited by 27 publications

References 38 publications

Novel charged sodium and calcium channel inhibitor active against neurogenic inflammation

Novel charged sodium and calcium channel inhibitor active against neurogenic inflammation

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

Managing rebound pain after regional anesthesia

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