Liposomal Bupivacaine During Robotic Colpopexy and Posterior Repair

Yeung, Jennifer; Crisp, Catrina C.; Mazloomdoost, Donna; Kleeman, Steven D.; Pauls, Rachel N.

doi:10.1097/aog.0000000000002375

Cited by 31 publications

(34 citation statements)

References 31 publications

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“…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).…”

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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Section: Pain Management: Bupivacainementioning

confidence: 99%

Section: Pain Management: Bupivacainementioning

confidence: 99%

Nanomedicine review: clinical developments in liposomal applications

et al. 2019

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“…[27][28][29][30][31][32][33][34][35][36][37] . Six studies included patients undergoing abdominal hysterectomy, laparoscopy with perineal/vaginal procedures or obstetric surgery [27][28][29][30][31][32] ; 3 studies were trial registrations of full texts that were already included in the review [33][34][35] ; 2 studies used different interventions e.g. sacrocolpopexy [36,37] ; and 1 study assessed a different outcome -gluteal pain instead of perineal pain.…”

Section: Resultsmentioning

confidence: 99%

The effectiveness of Bupivacaine as a pre-emptivepudendal block among patients undergoing vaginal surgeries: meta-analysis of randomized controlled trials

Rafique

Thompson

Al‐Jaroudi

et al. 2019

Preprint

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Background: Pre-emptive analgesia using pudendal nerve block (PNB) with bupivacaine is commonly used in clinical practice during pelvic floor and vaginal surgeries. However, its effectiveness is unclear. To update the evidence base we summarised short- and intermediate-term outcomes of pre-emptive analgesia using pudendal nerve block with bupivacaine as an approach in the management of pelvic floor and vaginal surgeries. Methods: We searched the CENTRAL, PubMed, ClinicalTrials.gov, google scholar and Open Grey from inception until April 2019. The citation lists of relevant papers were also searched. Randomized controlled trials (RCTs) of women who underwent perineal, pelvic floor or vaginal surgeries and received pre-emptive analgesia using a pudendal nerve block were included. Two authors independently screened and selected eligible trials as well as performed data extraction and quality assessment. Disagreements were resolved via consensus and an adjudicator was involved when consensus was not achieved. Data was narratively synthesized, when possible, data was pooled in RevMan 5 using random effects model. Results: Four RCTs with a total of 349 participants were eligible for inclusion. We found evidence of small effect for improvement in post-operative pain scores; requirements for opioids, SMD: -0.89 (95% CI: -1.19, -0.59) and non-steroidal anti-inflammatories SMD -1.04 (95% CI: -1.64, -0.43) in favour of the PNB versus control group. The risk ratio for adverse effects 0.42 (95% CI: 0.18, 0.99) favoured PNB. There was no significant difference between groups for length of hospital stay, MD: -0.82 (95% CI: -5.34, 3.69) and return to normal activity. Conclusion:We found inconclusive evidence that pre-emptive pudendal block using bupivacaine may improve postoperative pain and recovery in perineal, pelvic floor or vaginal surgeries. However, due to the scant and poor quality of evidence included in this systematic review, well-designed and adequately powered RCTs that adhere to reporting guidelines and evaluate key outcomes are needed to inform clinical guidelines on the use of pre-emptive pudendal block. Key words:pre-emptive analgesia, bupivacaine, pudendal nerve block, vaginal surgery, pelvic organ prolapse, systematic review, meta-analysis

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“…Reviews of RSC concluded that RSC has more post-operative pain than LSC (22,23). Interestingly, when bupivacaine was injected into the incision sites during a RSC, there was no significant improvement in pain scores as compared to saline (72). When RSC was compared to vaginal native tissue repair, the RSC group used fewer narcotic equivalents although there were no differences in pain scales (73).…”

Section: Surgical Risks/complications Of Robotic-assisted Repairsmentioning

confidence: 99%

Robotic-assisted repair of pelvic organ prolapse: a scoping review of the literature

Schachar¹,

Matthews²

2020

Transl Androl Urol

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The purpose of this article is to perform a scoping review of the medical literature regarding the efficacy, safety, and cost of robotic-assisted procedures for repair of pelvic organ prolapse in females.Sacrocolpopexy is the "gold standard" repair for apical prolapse for those who desire to maintain their sexual function, and minimally-invasive approaches offer similar efficacy with fewer risks than open techniques.The introduction of robotic technology has significantly impacted the field, converting what would have been a large number of open abdominal sacrocolpopexy (ASC) procedures to a minimally-invasive approach in the United States. Newer techniques such as nerve-sparing dissection at the sacral promontory, use of the iliopectineal ligaments and natural orifice vaginal sacrocolpopexy may improve patient outcomes. Prolapse recurrence is consistently noted in at least 10% of patients regardless of route of mesh placement. Ancillary factors including pre-operative prolapse stage, retention of the cervix, type of mesh implant, and genital hiatus (GH) size all adversely affect surgical efficacy, while trainees do not. Minimally-invasive apical repair procedures are suited to early recovery after surgery protocols but may not be appropriate for all patients.Studies evaluating longer-term outcomes of robotic sacrocolpopexies are needed to understand the relative risk/benefit ratio of this technique. With several emerging robotic platforms with improved features and a focus on decreasing costs, the future of robotics seems bright.

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Liposomal Bupivacaine During Robotic Colpopexy and Posterior Repair

Abstract: ClinicalTrials.gov, NCT02449915.

Cited by 31 publications

References 31 publications

Nanomedicine review: clinical developments in liposomal applications

Nanomedicine review: clinical developments in liposomal applications

The effectiveness of Bupivacaine as a pre-emptivepudendal block among patients undergoing vaginal surgeries: meta-analysis of randomized controlled trials

Robotic-assisted repair of pelvic organ prolapse: a scoping review of the literature

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