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Anais Brasileiros de Dermatologia 2020Local anesthetics are essential medications for the conduction of dermatological procedures. They stop the depolarization of nerve fibers and are divided into two main... (Review)
Review
Local anesthetics are essential medications for the conduction of dermatological procedures. They stop the depolarization of nerve fibers and are divided into two main categories, the amide and ester types. Systemic toxicity with reflex on the central nervous and cardiovascular systems is their most feared adverse reactions, and the anaphylactic reaction is the most concerning one. Although potentially fatal, these events are extremely rare, so local anesthetics are considered safe for use in in-office procedures.
Topics: Anesthetics, Local; Bupivacaine; Drug Hypersensitivity; Epinephrine; Humans; Lidocaine; Mepivacaine; Risk Factors; Time Factors
PubMed: 31952994
DOI: 10.1016/j.abd.2019.09.025 -
Anesthesiology Feb 2021The authors provide a comprehensive summary of all randomized, controlled trials (n = 76) involving the clinical administration of liposomal bupivacaine (Exparel; Pacira... (Review)
Review
The authors provide a comprehensive summary of all randomized, controlled trials (n = 76) involving the clinical administration of liposomal bupivacaine (Exparel; Pacira Pharmaceuticals, USA) to control postoperative pain that are currently published. When infiltrated surgically and compared with unencapsulated bupivacaine or ropivacaine, only 11% of trials (4 of 36) reported a clinically relevant and statistically significant improvement in the primary outcome favoring liposomal bupivacaine. Ninety-two percent of trials (11 of 12) suggested a peripheral nerve block with unencapsulated bupivacaine provides superior analgesia to infiltrated liposomal bupivacaine. Results were mixed for the 16 trials comparing liposomal and unencapsulated bupivacaine, both within peripheral nerve blocks. Overall, of the trials deemed at high risk for bias, 84% (16 of 19) reported statistically significant differences for their primary outcome measure(s) compared with only 14% (4 of 28) of those with a low risk of bias. The preponderance of evidence fails to support the routine use of liposomal bupivacaine over standard local anesthetics.
Topics: Anesthetics, Local; Bupivacaine; Humans; Liposomes; Nerve Block; Pain Management; Pain, Postoperative; Peripheral Nerves; Treatment Outcome
PubMed: 33372949
DOI: 10.1097/ALN.0000000000003630 -
Veterinary Medicine and Science May 2020Pain management in veterinary patients is a crucial component of appropriate patient care. Multimodal analgesia that includes both systemically and locally/regionally... (Review)
Review
Pain management in veterinary patients is a crucial component of appropriate patient care. Multimodal analgesia that includes both systemically and locally/regionally administered drugs is generally the most effective approach to providing pain relief. Local anaesthetic drugs used in local and regional blockade are unique in that they can completely block the transmission of pain (in conscious patients) or nociceptive (in anaesthetized patients) signals, thereby providing profound analgesia. In addition, local and regional administration of drugs, when compared with systemic bolus administration, generally results in a lower incidence of dose-related adverse effects. Due to the potential to provide profound analgesia and the high safety margin (when used correctly) of this drug class, local anaesthetics are recommended as part of the analgesic protocol in the majority of patients undergoing surgical procedures or suffering traumatic injuries. This manuscript, Part 1 of a two-part instalment, emphasizes the importance of using local and regional anaesthesia as a component of multimodal analgesia, provides a review of the basic pharmacokinetics/pharmacodynamics of local anaesthetic drugs in general, lists information on commonly used local anaesthetic drugs for local and regional blockade in dogs and cats, and briefly introduces the novel liposome-encapsulated bupivacaine (NOCITA®). Part 2 is a review of local and regional anaesthetic techniques used in dogs and cats (Grubb & Lobprise, 2020).
Topics: Anesthesia, Conduction; Anesthesia, Local; Anesthetics, Local; Animals; Bupivacaine; Cats; Dogs; Pain Management
PubMed: 31965742
DOI: 10.1002/vms3.219 -
Anesthesiology Mar 2022The interscalene nerve block provides analgesia for shoulder surgery. To extend block duration, provide adequate analgesia, and minimize opioid consumption, the use of... (Comparative Study)
Comparative Study Randomized Controlled Trial
BACKGROUND
The interscalene nerve block provides analgesia for shoulder surgery. To extend block duration, provide adequate analgesia, and minimize opioid consumption, the use of adjuvants such as dexamethasone as well as the application of perineural liposomal bupivacaine have been proposed. This randomized, double-blinded, noninferiority trial hypothesized that perineural liposomal bupivacaine is noninferior to standard bupivacaine with perineural dexamethasone in respect to average pain scores in the first 72 h after surgery.
METHODS
A total of 112 patients undergoing ambulatory shoulder surgery were randomized into two groups. The liposomal bupivacaine group received a 15-ml premixed admixture of 10 ml of 133 mg liposomal bupivacaine and 5 ml of 0.5% bupivacaine (n = 55), while the bupivacaine with dexamethasone group received an admixture of 15 ml of 0.5% standard bupivacaine with 4 mg dexamethasone (n = 56), respectively. The primary outcome was the average numerical rating scale pain scores at rest over 72 h. The mean difference between the two groups was compared against a noninferiority margin of 1.3. Secondary outcomes were analgesic block duration, motor and sensory resolution, opioid consumption, numerical rating scale pain scores at rest and movement on postoperative days 1 to 4 and again on postoperative day 7, patient satisfaction, readiness for postanesthesia care unit discharge, and adverse events.
RESULTS
A liposomal bupivacaine group average numerical rating scale pain score over 72 h was not inferior to the bupivacaine with dexamethasone group (mean [SD], 2.4 [1.9] vs. 3.4 [1.9]; mean difference [95% CI], -1.1 [-1.8, -0.4]; P < 0.001 for noninferiority). There was no significant difference in duration of analgesia between the groups (26 [20, 42] h vs. 27 [20, 39] h; P = 0.851). Motor and sensory resolutions were similar in both groups: 27 (21, 48) h versus 27 (19, 40) h (P = 0.436) and 27 [21, 44] h versus 31 (20, 42) h (P = 0.862), respectively. There was no difference in opioid consumption, readiness for postanesthesia care unit discharge, or adverse events.
CONCLUSIONS
Interscalene nerve blocks with perineural liposomal bupivacaine provided effective analgesia similar to the perineural standard bupivacaine with dexamethasone. The results show that bupivacaine with dexamethasone can be used interchangeably with liposomal bupivacaine for analgesia after shoulder surgery.
Topics: Adult; Ambulatory Surgical Procedures; Anesthetics, Local; Anti-Inflammatory Agents; Brachial Plexus Block; Bupivacaine; Dexamethasone; Double-Blind Method; Female; Humans; Male; Middle Aged; Pain, Postoperative; Shoulder
PubMed: 35041742
DOI: 10.1097/ALN.0000000000004111 -
American Journal of Health-system... Oct 2021
Topics: Anesthetics, Local; Anti-Inflammatory Agents, Non-Steroidal; Bupivacaine; Humans; Meloxicam; Pain, Postoperative
PubMed: 34398228
DOI: 10.1093/ajhp/zxab304 -
The Journal of Thoracic and... May 2021
Topics: Bupivacaine; Epinephrine; Humans; Liposomes; Lung
PubMed: 32448682
DOI: 10.1016/j.jtcvs.2020.01.113 -
The Annals of Thoracic Surgery Nov 2019
Topics: Bupivacaine; Sternotomy
PubMed: 31059679
DOI: 10.1016/j.athoracsur.2019.03.095 -
Neurosurgery Clinics of North America Jul 2022Neurosurgeons have sought to minimize the use of opioids in neurosurgery. Preoperative medical strategies include methadone and gabapentinoids. Intraoperative strategies... (Review)
Review
Neurosurgeons have sought to minimize the use of opioids in neurosurgery. Preoperative medical strategies include methadone and gabapentinoids. Intraoperative strategies include local anesthetic infiltration with bupivacaine, ropivacaine, and lidocaine; scalp block; steroids such as methylprednisolone, triamcinolone, and dexamethasone; ketamine; acetaminophen; ketorolac; liposomal bupivacaine; dexmedetomidine; and performing awake surgery. Postoperative strategies include continuous infusion pumps, wound catheters, and patient-controlled analgesia. Multimodal analgesia may be most effective, with the enhanced recovery after surgery (ERAS) pathway as an example and cognitive-behavioral therapy (CBT) as an adjunct. Patient-specific demographics and clinical factors must be considered in selecting the appropriate approach for a given patient.
Topics: Analgesics, Non-Narcotic; Analgesics, Opioid; Anesthetics, Local; Brain Neoplasms; Bupivacaine; Humans; Neurosurgery; Pain, Postoperative; Wakefulness
PubMed: 35718395
DOI: 10.1016/j.nec.2022.02.004 -
Pain Physician Jan 2021
Topics: Bupivacaine; Dexmedetomidine; Humans; Ultrasonography; Ultrasonography, Interventional
PubMed: 33400447
DOI: No ID Found -
A&A Practice Jan 2020
Topics: Bupivacaine; Chest Pain; Humans; Intercostal Nerves
PubMed: 31833839
DOI: 10.1213/XAA.0000000000001150