Liposomal bupivacaine decreases pain following retropubic sling placement: a randomized placebo-controlled trial

Mazloomdoost, Donna; Pauls, Rachel N.; Hennen, E.; Yeung, Jennifer Y.; Smith, Benjamin C.; Kleeman, Steven D.; Crisp, Catrina C.

doi:10.1016/j.ajog.2017.07.001

Cited by 31 publications

(54 citation statements)

References 31 publications

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“…Some of these studies have relied on targeting specific nerves or using expensive long-acting medications limiting their wide application. 8,9 Our study supports the finding that injections into the levator muscles, specifically puborectalis and iliococcygeus, with 0.5% bupivacaine after posterior colporrhaphy did not reduce pain, decrease supplementation of opioid use, decrease time to pass a postoperative void trial, or decrease time to first postoperative bowel movement compared with placebo. In short, there does not seem to be any benefit to injecting the levator muscles in this surgical context to improve the assessed clinical parameters.…”

Section: Discussionsupporting

confidence: 82%

Bupivacaine Use After Posterior Colporrhaphy to Reduce Postoperative Pain: A Multicenter, Double-Blinded, Placebo-Controlled, Randomized Clinical Trial

Kaeser

Rothenberger

Zoorob

et al. 2021

Female Pelvic Med Reconstr Surg

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The aim of this study was to determine if injection of bupivacaine into levator muscles after posterior colporrhaphy reduces postoperative pain.Methods: This study was a multicenter, double-blinded, placebo-controlled, randomized clinical trial of 130 participants, comparing bilateral infiltration of puborectalis and iliococcygeus muscles with 0.5% bupivacaine without epinephrine or normal saline after vaginal prolapse repair that included a posterior colporrhaphy. Primary outcome was the 24-hour cumulative Visual Analog Scale (VAS) pain score (measured as a sum of VAS pain scores at postoperative hours 0, 4, 8, 16, and 24) across intervention allocations. Secondary outcomes include the individual VAS pain scores per postoperative times 0, 4, 8, 16, and 24 hours and at 1 and 2 weeks, morphine equivalent use, postoperative void trial success, and time to first bowel movement.Results: Sixty-eight participants received bupivacaine, and 62 participants received normal saline. No significant differences were identified in the 24-hour postoperative cumulative VAS pain scores for the bupivacaine and normal saline arms, 19 and 18 (P = 0.71); individual pain scores per each postoperative assessment time; opiate use (24-hour use was 42 vs 48, P = 0.39; 48-hour use was 75 vs 37, P = 0.09); length of hospital stay (26 hours vs 22 hours, P = 0.069); hours to passing void trial (10 hours vs 12 hours, P = 0.17); or hours to first postoperative bowel movement (18 hours vs 12 hours, P = 0.78).Conclusions: Use of bupivacaine for muscle block after posterior colporrhaphy does not reduce postoperative pain, opiate use, and time to first bowel movement, or increase void trial success.

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Section: Discussionsupporting

confidence: 82%

Bupivacaine Use After Posterior Colporrhaphy to Reduce Postoperative Pain: A Multicenter, Double-Blinded, Placebo-Controlled, Randomized Clinical Trial

Kaeser

Rothenberger

Zoorob

et al. 2021

Female Pelvic Med Reconstr Surg

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“…The highest Cmax was observed in an individual taking the second dose 24 h after the first, but was below toxic levels for central nervous system and cardiac. In general, LB was well tolerated and revealed no clinically relevant unsafety signs (Rice et al 2017), provided excellent pain scores, lower opioids consumption, and at a lower cost (Mazloomdoost et al 2017;Sabesan et al 2017;Mcgraw-tatum et al 2017;Davidovitch et al 2017;Johnson et al 2017;Barron et al 2016). Thus, liposome formulation of the anesthetic rendered longer therapeutic times with no adverse effects.…”

Section: Pain Management: Bupivacainementioning

confidence: 87%

“…Liposomal bupivacaine (Exparel ® , Pacira Pharmaceuticals, San Diego, CA) was approved for local surgical site injection for postoperative pain after haemorrhoidectomy and bunionectomy by the US FDA in 2011 (Yeung et al 2018). Each liposomal bupivacaine particle (DepoFoam ® , Pacira Pharmaceuticals, Parsippany, NJ) is composed of a honeycomb-like structure of internal aqueous chambers containing encapsulated bupivacaine (Mazloomdoost et al 2017). A single dose (266 mg) of encapsulated bupivacaine amidebased local anesthetic is injected directly into the surgical site.…”

Section: Pain Management: Bupivacainementioning

confidence: 99%

“…A slow-release mechanism involving reorganization of the barrier lipid membranes is sustained for up to 92 h with concomitant pain control for up to 72 h, as compared to 7-12 h with standard bupivacaine. Studies show bupivacaine decreased pain compared to placebo, the use of opioids and the hospital costs (Yeung et al 2018;Mazloomdoost et al 2017;Sabesan et al 2017;Declaire et al 2017;Smith et al 2017;Mcgraw-tatum et al 2017;Abildgaard et al 2017;Alijanipour et al 2016;Davidovitch et al 2017). Although the liposomal bupivacaine is not a nanoparticle (3-30 μm mean diameter), it is mentioned here because it is one of the most recent liposomal formulations approved.…”

Section: Pain Management: Bupivacainementioning

confidence: 99%

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Nanomedicine review: clinical developments in liposomal applications

et al. 2019

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Background Many conventional drugs exhibit poor pharmacokinetics, limited bioavailability and a high toxicity, all of which restrain their use. To overcome these issues and improve the therapeutic indexes of the drug, the emergent fields of nanotechnology and nanomedicine have made significant progress in detection, diagnosis and treatment of several diseases at clinical level (Li et al. 2014; Yingchoncharoen et al. 2016; Signorell et al. 2018). In fact, thanks to nanoparticles and liposomes, it has been possible to decrease the toxicity and improve the pharmacokinetics parameters, such as distribution, increased circulation time, targeted controlled release, increased intracellular concentration, and

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“…21,22 Similar outcomes have also been documented in nonorthopedic cases, including hemorrhoidectomy, bunionectomy, and colorectal and retropubic slingplacement surgeries. 16,17,23,24 Despite these findings, the local anesthetic's effectiveness in reducing postoperative pain and opioid use in spine surgeries has not been well defined.…”

Section: Discussionmentioning

confidence: 99%

The Efficacy of Liposomal Bupivacaine in Lumbar Spine Surgery

Brown¹,

Weir²,

Shasti³

et al. 2018

Int J Spine Surg

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Background: Postoperative pain management in spine surgery holds unique challenges. The purpose of this study is to determine if the local anesthetic liposomal bupivacaine (LB) reduces the total opioid requirement in the first 3 days following posterior lumbar decompression and fusion (PLDF) surgery for degenerative spondylosis.Methods: Fifty patients underwent PLDF surgery in a prospective randomized control pilot trial between August 2015 and October 2016 and were equally allocated to either a treatment (LB) or a control (saline) group. Assessments included the 72-hour postoperative opioid requirement normalized to 1 morphine milligram equivalent (MME), visual analog scale (VAS), and hospital length of stay.Results: LB did not significantly alter the 72-hour postoperative opioid requirement compared to saline (11.6 vs. 13.4 MME, P ¼ .40). In a subgroup analysis, there was also no significant difference in opioid consumption among narcotic-naive patients with either LB or saline. Among narcotic tolerant patients, however, opioid consumption was higher with saline than LB (20.6 MME vs. 13.3 MME, P ¼ .048). Additionally, pre-and postoperative VAS scores and hospital length of stay were not significantly different with either LB or saline.Conclusions: In the setting of PLDF surgery, LB injections did not significantly reduce the consumption of opioids in the first 3 postoperative days, nor did the hospital length of stay or VAS pain scores, compared to saline. However, LB could be beneficial in reducing the consumption of opioids in narcotic-tolerant populations.Level of Evidence: 2.

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Liposomal bupivacaine decreases pain following retropubic sling placement: a randomized placebo-controlled trial

Cited by 31 publications

References 31 publications

Bupivacaine Use After Posterior Colporrhaphy to Reduce Postoperative Pain: A Multicenter, Double-Blinded, Placebo-Controlled, Randomized Clinical Trial

Bupivacaine Use After Posterior Colporrhaphy to Reduce Postoperative Pain: A Multicenter, Double-Blinded, Placebo-Controlled, Randomized Clinical Trial

Nanomedicine review: clinical developments in liposomal applications

The Efficacy of Liposomal Bupivacaine in Lumbar Spine Surgery

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