Incidence and severity of short‐term incisional complications after intraoperative local infiltration of liposomal bupivacaine in dogs

Abstract

Objective To report the incidence of short‐term incisional complications in dogs receiving intraoperative local infiltration of liposomal bupivacaine. Study design Retrospective study. Animals Client‐owned dogs (n = 218). Methods Medical records were searched for dogs whose surgical site was infiltrated with liposomal bupivacaine. Records were reviewed for complications within 20 days postoperatively. Cases were categorized by: (1) surgical wound classification (clean, clean‐contaminated, contaminated); (2) labeled versus off‐label use in orthopedic surgery – stifle surgery to address cranial cruciate ligament (CCL) disease versus other orthopedic procedures; and (3) orthopedic versus soft‐tissue surgery. Results Complications were documented in 43/218 (19.7%) records, including 27/218 (12.4%) complications that resolved spontaneously or with topical treatment. The incidence of short‐term incisional complications did not differ between surgical wound classifications (P = 0.55) or between labeled versus off‐label use in orthopedic surgery (P = 0.21). Complications seemed more common after soft‐tissue procedures (32/123; 26.0%) than orthopedic procedures (11/95; 11.6%) (P < 0.01). Conclusion Surgical wound classification or type of orthopedic procedure did not seem to influence incisional complications of infiltrated surgical sites. Complications were more common after soft‐tissue procedures than orthopedic procedures. Clinical significance Infiltration of surgical sites with liposomal bupivacaine seems safe in a broader range of orthopedic procedures than currently labeled. The results also justify further investigation in soft‐tissue surgery.

Postoperative injectable opioid use and incidence of surgical site complications after use of liposomal bupivacaine in canine gastrointestinal foreign body surgery

“…Liposomal bupivacaine (5.3 mg/kg) was locally infiltrated by the surgeon at the end of surgery in 65 dogs but the exact tissue layer and timing varied: "before abdominal wall closure" (21 dogs), "after abdominal wall closure" (2), external rectus muscle (1), subcutaneous (11), injected within the body of the external rectus muscle and subcutaneous (10), T A B L E 1 Patient parameters and surgical information for the dogs that received LB and those that did not. Note: A Wilcoxon rank sum test was used to determine difference between groups, with median (range) stated.…”

“…4 More recently, local incisional complications have been reported in 43/218 canine surgeries (19.7%) with local infiltration of LB, with a higher incidence in soft tissue (32/123; 26.0%) than orthopedic (11/95; 11.6%) procedures. 11 Complications were noted more commonly in contaminated (30.8%) than in clean (18.8%), or cleancontaminated (23.1%) surgeries. In a prospective canine study, redness and inflammation around the laparotomy incisions treated with LB was observed in 276/321 dogs in hospital and in 80 at the 2 week recheck.…”

“…In dogs, no differences in adverse events were found between use of LB and 0.5% bupivacaine hydrochloride when used as an incisional infiltration block undergoing tibial plateau leveling osteotomy (TPLO) 3 or lateral suture placement 4 . More recently, local incisional complications have been reported in 43/218 canine surgeries (19.7%) with local infiltration of LB, with a higher incidence in soft tissue (32/123; 26.0%) than orthopedic (11/95; 11.6%) procedures 11 . Complications were noted more commonly in contaminated (30.8%) than in clean (18.8%), or clean‐contaminated (23.1%) surgeries.…”

Use of liposomal bupivacaine in dogs and cats undergoing gastrointestinal surgery is not associated with a higher rate of surgical site infections or multidrug-resistant infections

“…8 This study did not report the bacterium isolated, nor did it indicate whether dogs diagnosed with SSI had surgeries performed under clean-contaminated or dirty conditions. Another study 9 found that the incidence of wound complications after infiltration of liposomal bupivacaine in dogs did not vary significantly between clean, clean-contaminated, and dirty surgeries but that the overall wound complication rate was 19.7%, with contaminated and clean-contaminated surgeries having high complication rates of 30.8% and 23.1%, respectively. The overall rate of SSI reported was 5%, but the rate of SSI for clean, clean-contaminated, or contaminated surgeries was not reported.…”

“…The overall rate of SSI reported was 5%, but the rate of SSI for clean, clean-contaminated, or contaminated surgeries was not reported. 9 In human medicine, SSI is listed as a potential complication of liposomal bupivacaine administration. Some reports support an increased risk of SSI with use of liposomal bupivacaine, particularly in skin graft donor sites and after arthroplasty.…”