Evolving Role of Local Anesthetics in Managing Postsurgical Analgesia

Golembiewski, Julie; Dasta, Joseph F.

doi:10.1016/j.clinthera.2015.03.017

Cited by 58 publications

(39 citation statements)

References 125 publications

(172 reference statements)

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“…Using this technology, Liposomal bupivacaine (Exparel; Pacira Pharmaceuticals, Inc., Parsippany, NJ) was recently approved by the U.S. Food and Drug Administration (FDA) for postsurgical analgesia to release bupivacaine slowly over 96 hours. There has been enough literature evidence over the past ten years showing the efficacy of liposomal bupivacaine in statistically significant reduction of cumulative pain scores over 72 hours following wound infiltration after various surgical procedures [24]. The only other single-center ERAS study in the LDN population has used transversus abdominis plane block (TAP) with 0.5% Ropivacaine [7].…”

Section: Discussionmentioning

confidence: 99%

Could the Use of an Enhanced Recovery Protocol in Laparoscopic Donor Nephrectomy Be an Incentive for Live Kidney Donation?

Rege¹,

Leraas²,

Vikraman³

et al. 2016

Cureus

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Introduction and Background: Gastrointestinal (GI) recovery after major abdominal surgery can be delayed from an ongoing need for narcotic analgesia thereby prolonging hospitalization. Enhanced recovery after surgery (ERAS) is a multimodal perioperative care pathway designed to facilitate early recovery after major surgery by maintaining preoperative body composition and physiological organ function and modifying the stress response induced by surgical exposure. Enhanced recovery programs (ERPs) in colorectal surgery have decreased the duration of postoperative ileus and the hospital stay while showing equivalent morbidity, mortality, and readmission rates in comparison to the traditional standard of care. This study is a pilot trial to evaluate the benefits of ERAS protocols in living kidney donors undergoing laparoscopic nephrectomy.Methods: This is a single-center, non-randomized, retrospective analysis comparing the outcomes of the first 40 live kidney donors subjected to laparoscopic nephrectomy under the ERAS protocol to 40 donors operated prior to ERAS with traditional standard of care. Our ERAS protocol includes reduced duration of fasting with preoperative carbohydrate loading, intraoperative fluid restriction to 3 ml/kg/hr, target urine output of 0.5 ml/kg/hr, use of subfascial Exparel injection (bupivacaine liposome suspension), and postoperative narcotic-free pain regimen with acetaminophen, ketorolac, or tramadol. Short-term patient outcomes were compared using Pearsons’s Chi-Squared test for categorical variables and the Kruskal-Wallis test for continuous variables. Additionally, a multivariate analysis was conducted to evaluate factors influencing patient length of stay and likelihood of readmission.Results: ERAS protocol reduced the postoperative median length of stay decreased from 2.0 to 1.0 days (p=0.001). Overall pain scores were significantly lower in the ERAS group (peak pain score 6.0 vs. 8.00, p< 0.001; morning after surgery pain score 3.0 vs. 7.0, p=0.001; lowest pain score 0.0 vs. 2.0, p=0.016) despite the absence of postoperative narcotics. The average duration of surgery was shorter in the ERAS group (248 vs. 304 minutes, p<0.001). The average amount of intraoperative fluid used was significantly lower in the ERAS group (2500 ml vs. 3525 ml, p<0.001) without affecting the donor renal function. The incidence of delayed graft function was similar in the two groups (p=0.541). A trend toward lower readmission was noted with the ERAS protocol (12.8% vs. 27.5%, p=0.105). GI dysfunction was the most common reason for readmission.Conclusion: Application of an ERAS protocol in a laparoscopic living donor nephrectomy was associated with reduced length of hospitalization and improved pain scores related likely to intraoperative use of subfascial Exparel and a shorter duration of ileus. Restricted use of intraoperative fluids prevents excessive third spacing and bowel edema, enhancing gut recovery without adversely impacting recipient graft function. This study suggests that ERAS has the potential...

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Section: Discussionmentioning

confidence: 99%

Could the Use of an Enhanced Recovery Protocol in Laparoscopic Donor Nephrectomy Be an Incentive for Live Kidney Donation?

Rege¹,

Leraas²,

Vikraman³

et al. 2016

Cureus

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“…[8] However, the utility of traditional local anesthetic formulations has been limited by their short duration of action. [9,10] Liposomal bupivacaine (EXPAREL) is a prolonged-release formulation of bupivacaine indicated for single-dose administration into the surgical site to produce postsurgical analgesia. [11,12] Several studies have suggested that liposomal bupivacaine significantly alleviates pain and improves quality outcomes in THA patients.…”

Section: Introductionmentioning

confidence: 99%

Liposomal bupivacaine versus traditional bupivacaine for pain control after total hip arthroplasty

Ma¹,

Wang

Jiang³

et al. 2017

Medicine

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Background:In the past, the efficacy of local infiltration of liposomal bupivacaine for total hip arthroplasty (THA) patients was in debate. Therefore, this meta-analysis was conducted to determine whether local infiltration of liposomal bupivacaine provides better pain relief after THA.Methods:We searched Web of Science, PubMed, Embase, and the Cochrane Library databases to the April 2017. Any studies comparing liposomal bupivacaine and traditional bupivacaine were included in our meta-analysis. The outcomes included visual analog scale (VAS) at 24, 48, and 72 hours, total morphine consumption at 24 hours, and the length of hospital stay. We assessed the pooled data using a random-effect model.Results:Six studies were finally included in this meta-analysis. Our pooled data analysis demonstrated that liposomal bupivacaine was more effective than the traditional bupivacaine in terms of VAS at 24 hours (P = .018) and the length of hospital stay (P = .000). There was no significant difference in terms of the VAS at 48 and 72 hours and total morphine consumption at 24 hours (P >.05).Conclusion:Compared with the traditional bupivacaine, liposomal bupivacaine shows better pain control at 24 hours and reduces the length of hospital stay after THA. Its economic costs must be assessed in multimodal center randomized controlled trials when being recommended as a long-acting alternative analgesic agent for a THA patient.

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“…8 Topical anesthetics represent important components of multimodal analgesic regimens for surgical wound and proved efficacy and tolerability when administered appropriately. 9 Respecting the role and effectiveness of open haemorrhoidectomy and on trial to minimize complications associated with this procedure, two topical ointment formulations (sucralfate 10% and lidocaine 5%) were investigated and compared in this study for their efficacy on postoperative pain and wound healing following open haemorrhoidectomy.…”

Section: Introductionmentioning

confidence: 99%

Double blinded randomized placebo-controlled comparative study between sucralfate ointment and lidocaine ointment after Milligan Morgan hemorrhoidectomy

Alkhateep

Fareed

2017

Int Surg J

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Background: Post haemorrhoidectomy pain and delayed wound healing are the most annoying drawbacks to the patients and the surgeons. Topical application of sucralfate or lidocaine may help in reducing postoperative pain and promoting wound healing after Milligan Morgan hemorrhoidectomy.Methods: This study was designed as a single-center double blinded randomized placebo controlled trial at the Department of general Surgery Menoufia University, immediately after Milligan Morgan Hemorrhoidectomy, a total of 150 patients were randomly assigned to receive either 10% Sucralfate ointment, 5% lidocaine ointment or placebo ointment (control group). The primary outcome measure was pain intensity measured by a visual analogue scale at different time points after hemorrhoidectomy and the secondary outcome measure was wound healing.Results: There was no significant difference in age, gender, and number of excised hemorrhoid piles between the two groups. At the 1st ,3rd and 7th days after surgery pain intensity was significantly lower in sucralfate group (4.18±0.82, 3.92±0.72, 3.56±0.67) when compared to lidocaine group (5.06±1.11, 4.70±0.84, 3.93±0.75) and placebo group (6.17±1.26, 5.42±0.98, 4.55±0.84). At the 21st and 28th days no significant difference in pain intensity between groups (p > 0.05) with better wound healing in sucralfate group (P<0.05).Conclusions: Sucralfate was able to reduce the acute postoperative pain and improve wound healing after hemorrhoidectomy, local anesthetic lidocaine could help in pain control but without effect on healing.

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Evolving Role of Local Anesthetics in Managing Postsurgical Analgesia

Cited by 58 publications

References 125 publications

Could the Use of an Enhanced Recovery Protocol in Laparoscopic Donor Nephrectomy Be an Incentive for Live Kidney Donation?

Could the Use of an Enhanced Recovery Protocol in Laparoscopic Donor Nephrectomy Be an Incentive for Live Kidney Donation?

Liposomal bupivacaine versus traditional bupivacaine for pain control after total hip arthroplasty

Double blinded randomized placebo-controlled comparative study between sucralfate ointment and lidocaine ointment after Milligan Morgan hemorrhoidectomy

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