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Regional Anesthesia and Pain Medicine Jun 2021
Topics: Anesthetics, Local; Bupivacaine; Humans; Pain, Postoperative
PubMed: 33837137
DOI: 10.1136/rapm-2021-102683 -
Regional Anesthesia and Pain Medicine Jun 2021Liposomal bupivacaine (LB) is a prolonged release formulation of conventional bupivacaine designed for prolonging local or peripheral regional single injection... (Meta-Analysis)
Meta-Analysis Review
The analgesic efficacy of liposomal bupivacaine compared with bupivacaine hydrochloride for the prevention of postoperative pain: a systematic review and meta-analysis with trial sequential analysis.
BACKGROUND/IMPORTANCE
Liposomal bupivacaine (LB) is a prolonged release formulation of conventional bupivacaine designed for prolonging local or peripheral regional single injection anesthesia. To this day, the benefit of the new substance on relevant end points is discussed controversial.
OBJECTIVE
The objective was to determine whether there is a difference in postoperative pain scores and morphine consumption between patients treated with LB and bupivacaine hydrochloride in a systematic review and meta-analysis.
EVIDENCE REVIEW
Randomized controlled trials (RCT) were identified in Embase, CENTRAL, MEDLINE and Web of Science up to May 2020. Risk of bias was assessed using Cochrane methodology. Primary end points were the mean pain score difference and the relative morphine equivalent (MEQ) consumption expressed as the ratio of means (ROM) 24 and 72 hours postoperatively.
FINDINGS
23 RCTs including 1867 patients were eligible for meta-analysis. The mean pain score difference at 24 hours postoperatively was significantly lower in the LB group, at -0.37 (95% CI -0.56 to -0.19). The relative MEQ consumption after 24 hours was also significantly lower in the LB group, at 0.85 (0.82 to 0.89). At 72 hours, the pain score difference was not significant at -0.25 (-0.71 to 0.20) and the MEQ ratio was 0.85 (0.77 to 0.95).
CONCLUSION
The beneficial effect on pain scores and opioid consumption was small but not clinically relevant, despite statistical significance. The effect was stable among all studies, indicating that it is independent of the application modality.
Topics: Analgesics; Analgesics, Opioid; Anesthetics, Local; Bupivacaine; Humans; Liposomes; Pain, Postoperative
PubMed: 33837139
DOI: 10.1136/rapm-2020-102427 -
Journal of Cardiothoracic and Vascular... May 2021
Topics: Anesthetics, Local; Bupivacaine; Humans; Intercostal Nerves; Pain, Postoperative; Thoracic Surgery
PubMed: 33563528
DOI: 10.1053/j.jvca.2021.01.023 -
Anesthesia and Analgesia 1971
Review
Topics: Analgesia; Anesthesia, Conduction; Anesthesia, Obstetrical; Anesthetics, Local; Bupivacaine; Chemical Phenomena; Chemistry; Chlorides; Female; Fetus; Humans; Infant, Newborn; Male; Maternal-Fetal Exchange; Methods; Pregnancy; Retrospective Studies; Sensation; Time Factors
PubMed: 4939842
DOI: No ID Found -
Anesthesia and Analgesia Dec 2020In women undergoing cesarean delivery under spinal anesthesia with intrathecal morphine, transversus abdominis plane (TAP) block with bupivacaine hydrochloride (HCl) may... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
In women undergoing cesarean delivery under spinal anesthesia with intrathecal morphine, transversus abdominis plane (TAP) block with bupivacaine hydrochloride (HCl) may not improve postsurgical analgesia. This lack of benefit could be related to the short duration of action of bupivacaine HCl. A retrospective study reported that TAP block with long-acting liposomal bupivacaine (LB) reduced opioid consumption and improved analgesia following cesarean delivery. Therefore, we performed a prospective multicenter, randomized, double-blind trial examining efficacy and safety of TAP block with LB plus bupivacaine HCl versus bupivacaine HCl alone.
METHODS
Women (n = 186) with term pregnancies undergoing elective cesarean delivery under spinal anesthesia were randomized (1:1) to TAP block with LB 266 mg plus bupivacaine HCl 50 mg or bupivacaine HCl 50 mg alone. Efficacy was evaluated in a protocol-compliant analysis (PCA) set that was defined a priori. The primary end point was total postsurgical opioid consumption (oral morphine equivalent dosing [MED]) through 72 hours. Pain intensity was measured using a visual analog scale. Adverse events (AEs) after treatment were recorded through day 14.
RESULTS
Total opioid consumption through 72 hours was reduced with LB plus bupivacaine HCl versus bupivacaine HCl alone (least squares mean [LSM] [standard error (SE)] MED, 15.5 mg [6.67 mg] vs 32.0 mg [6.25 mg]). This corresponded to an LSM treatment difference of -16.5 mg (95% confidence interval [CI], -30.8 to -2.2 mg; P = .012). The area under the curve of imputed pain intensity scores through 72 hours supported noninferiority of LB plus bupivacaine HCl versus bupivacaine HCl alone (LSM [SE], 147.9 [21.13] vs 178.5 [19.78]; LSM treatment difference, -30.6; 95% CI, -75.9 to 14.7), with a prespecified noninferiority margin of 36 (P = .002). In an analysis of all treated patients, including those not meeting criteria for inclusion in the PCA, there was no difference in postsurgical opioid consumption between groups. In the LB plus bupivacaine HCl group, 63.6% of patients experienced an AE after treatment versus 56.2% in the bupivacaine HCl-alone group. Serious AEs after treatment were rare (≈3% in both groups).
CONCLUSIONS
TAP block using LB plus bupivacaine HCl as part of a multimodal analgesia protocol incorporating intrathecal morphine resulted in reduced opioid consumption after cesarean delivery in the PCA set. Results suggest that with correct TAP block placement and adherence to a multimodal postsurgical analgesic regimen, there is an opioid-reducing benefit of adding LB to bupivacaine TAP blocks after cesarean delivery (ClinicalTrials.gov identifier: NCT03176459).
Topics: Abdominal Muscles; Adult; Anesthetics, Local; Bupivacaine; Cesarean Section; Double-Blind Method; Female; Humans; Liposomes; Middle Aged; Nerve Block; Pain, Postoperative; Pregnancy
PubMed: 32739962
DOI: 10.1213/ANE.0000000000005075 -
JAMA Surgery Jun 2022More than half of patients who undergo knee replacement surgery report substantial acute postoperative pain. (Randomized Controlled Trial)
Randomized Controlled Trial
Efficacy of Liposomal Bupivacaine and Bupivacaine Hydrochloride vs Bupivacaine Hydrochloride Alone as a Periarticular Anesthetic for Patients Undergoing Knee Replacement: A Randomized Clinical Trial.
IMPORTANCE
More than half of patients who undergo knee replacement surgery report substantial acute postoperative pain.
OBJECTIVE
To evaluate the efficacy and cost-effectiveness of periarticular liposomal bupivacaine for recovery and pain management after knee replacement.
DESIGN, SETTING, AND PARTICIPANTS
This multicenter, patient-blinded, pragmatic, randomized clinical superiority trial involved 533 participants at 11 institutions within the National Health Service in England. Adults undergoing primary unilateral knee replacement for symptomatic end-stage osteoarthritis were enrolled between March 29, 2018, and February 29, 2020, and followed up for 1 year after surgery. Follow-up was completed March 1, 2021. A per-protocol analysis for each coprimary outcome was performed in addition to the main intention-to-treat analysis.
INTERVENTIONS
Two hundred sixty-six milligrams of liposomal bupivacaine admixed with 100 mg of bupivacaine hydrochloride compared with 100 mg of bupivacaine hydrochloride alone (control) administered by periarticular injection at the time of surgery.
MAIN OUTCOME AND MEASURES
The coprimary outcomes were Quality of Recovery 40 (QoR-40) score at 72 hours and pain visual analog scale (VAS) score area under the curve (AUC) from 6 to 72 hours. Secondary outcomes included QoR-40 and mean pain VAS at days 0 (evening of surgery), 1, 2, and 3; cumulative opioid consumption for 72 hours; functional outcomes and quality of life at 6 weeks, 6 months, and 1 year; and cost-effectiveness for 1 year. Adverse events and serious adverse events up to 12 months after randomization were also assessed.
RESULTS
Among the 533 participants included in the analysis, the mean (SD) age was 69.0 (9.7) years; 287 patients were women (53.8%) and 246 were men (46.2%). Baseline characteristics were balanced between study groups. There was no difference between the liposomal bupivacaine and control groups in QoR-40 score at 72 hours (adjusted mean difference, 0.54 [97.5% CI, -2.05 to 3.13]; P = .64) or the pain VAS score AUC at 6 to 72 hours (-21.5 [97.5% CI, -46.8 to 3.8]; P = .06). Analyses of pain VAS and QoR-40 scores demonstrated only 1 statistically significant difference, with the liposomal bupivacaine arm having lower pain scores the evening of surgery (adjusted difference -0.54 [97.5% CI, -1.07 to -0.02]; P = .02). No difference in cumulative opioid consumption and functional outcomes was detected. Liposomal bupivacaine was not cost-effective compared with the control treatment. No difference in adverse or serious adverse events was found between the liposomal bupivacaine and control groups.
CONCLUSIONS AND RELEVANCE
This study found no difference in postoperative recovery or pain associated with the use of periarticular liposomal bupivacaine compared with bupivacaine hydrochloride alone in patients who underwent knee replacement surgery.
TRIAL REGISTRATION
isrctn.com Identifier: ISRCTN54191675.
Topics: Adult; Aged; Analgesics, Opioid; Anesthetics, Local; Bupivacaine; Female; Humans; Liposomes; Male; Pain, Postoperative; Quality of Life; State Medicine
PubMed: 35385072
DOI: 10.1001/jamasurg.2022.0713 -
Advances in Therapy May 2020This is a comprehensive review of the literature about the use of bupivacaine hydrochloride for the treatment of post-herpetic neuralgia (PHN). It briefly reviews the... (Review)
Review
PURPOSE OF REVIEW
This is a comprehensive review of the literature about the use of bupivacaine hydrochloride for the treatment of post-herpetic neuralgia (PHN). It briefly reviews the background, biology, diagnosis and conventional treatment for PHN, and then introduces and compares the recent evidence for the use of topical bupivacaine.
RECENT FINDINGS
PHN is defined by pain lasting 90 days or more after the initial presentation of herpes zoster ("Shingles", HZ) rash and is the most common complication of this disease. A product of re-activation of the Varicella-Zoster virus (VZV), HZ is diagnosed more than 1 million times annually in the United States. Approximately 20% of patients with HZ will experience PHN and will continue to suffer intermittent neuropathic symptoms, including itching and pain, that is sharp, stabbing, throbbing or burning, with the pain localized to the site of their original rash. This long-lasting pain compares with the severity of long-standing rheumatics and osteo-arthritis and is accompanied by severe allodynia causing significant suffering, and a financial burden that is manifested in both healthcare costs and loss of quality-adjusted life years. Prevention of PHN may be achieved with the Zoster vaccine, although there is still a large segment of unvaccinated population. Moreover, the Zoster vaccine is not always effective for prevention. Current treatment includes medical (systemic tricyclic antidepressants, anticonvulsants and opioids, topical lidocaine and capsaicin) and interventional (subcutaneous Botox injections, nerve blocks and nerve stimulation) therapies. These therapies are not always effective, and each carries their own profile of side effects and risks. Moreover, up to 50% of patients with PHN are refractory to management. Recent evidence is emerging to support the use of topical local anesthetics for the treatment of PHN. Two small studies recently found topical lidocaine spray to be effective in treating paroxysmal pain attacks associated with PHN. Bupivacaine is a longer-lasting local anesthetic, and a film-forming formulation allows easy and durable application to the affected skin. Recent studies show that topical film-forming bupivacaine is safe and as effective as lidocaine for the treatment of PHN. PHN is an important though common complication of HZ and can cause long-lasting pain and disability. Current treatment for PNH is limited by efficacy and safety profiles of individual therapies. Recent evidence points to topical local anesthetics as an effective and safe alternative to conventional therapy. Film-forming bupivacaine may offer a durable and safe option for this otherwise difficult to treat syndrome.
Topics: Analgesics; Analgesics, Opioid; Bupivacaine; Chronic Pain; Health Care Costs; Herpes Zoster; Humans; Neuralgia, Postherpetic
PubMed: 32297285
DOI: 10.1007/s12325-020-01335-9 -
Journal of Cardiothoracic and Vascular... May 2021The objective of this study was to compare the effects of liposomal bupivacaine (Lipo-B) and bupivacaine hydrochloride (B-HCl), in the presence of multimodal analgesia,... (Observational Study)
Observational Study
OBJECTIVES
The objective of this study was to compare the effects of liposomal bupivacaine (Lipo-B) and bupivacaine hydrochloride (B-HCl), in the presence of multimodal analgesia, on postoperative analgesia and opioid consumption in minimally invasive thoracic surgery (MITS) lobectomy.
DESIGN
Retrospective observational cohort study.
SETTING
Tertiary care cancer center.
PARTICIPANTS
A total of 60 patients who underwent MITS lobectomy and received intercostal nerve blockade (ICNB) with either 0.66% Lipo-B (n = 29) or 0.5% B-HCl (n = 31).
INTERVENTIONS
All patients received intravenous patient-controlled analgesia for the first 12 hours postoperatively, followed by opioids and nonsteroidal anti-inflammatory drugs as needed.
MEASUREMENTS AND MAIN RESULTS
Perioperative opioid and nonopioid consumption and pain scores were compared between groups at 12-hour intervals for the first 72 hours. Between the two groups, there were no statistically significant differences in demographic characteristics, intraoperative (p = 0.46) and postoperative opioid consumption, Richmond Agitation-Sedation Scale scores and pain scores upon postanesthesia care unit arrival and after four hours, length of postanesthesia care unit stay (p = 0.84), or length of hospital stay (p = 0.55). Both groups received intra- and postoperative multimodal analgesia.
CONCLUSIONS
In this cohort, no differences in opioid consumption or pain scores were observed in the immediate postoperative period following MITS lobectomy between patients given ICNB with Lipo-B and those given ICNB with B-HCl in the presence of multimodal analgesia.
Topics: Analgesics, Opioid; Anesthetics, Local; Bupivacaine; Humans; Intercostal Nerves; Pain, Postoperative; Retrospective Studies; Thoracic Surgery
PubMed: 33376072
DOI: 10.1053/j.jvca.2020.11.067 -
Journal of Minimally Invasive Gynecology 2019To study the effects of liposomal bupivacaine (LB) compared with bupivacaine hydrochloride with lidocaine on postoperative day 1 pain scores. (Randomized Controlled Trial)
Randomized Controlled Trial
STUDY OBJECTIVE
To study the effects of liposomal bupivacaine (LB) compared with bupivacaine hydrochloride with lidocaine on postoperative day 1 pain scores.
DESIGN
A randomized controlled trial (Canadian Task Force classification 1).
SETTING
An academic medical center within the department of female pelvic medicine and reconstructive surgery.
PATIENTS
Fifty-seven patients undergoing midurethral sling placement by a fellowship-trained urogynecologic surgeon and a fellow in female pelvic medicine and reconstructive surgery.
INTERVENTIONS
Fifty-seven patients were enrolled to participate in this study. There were 24 patients randomized to receive liposomal bupivacaine and 33 to receive a mixture of bupivacaine and lidocaine during the placement of a retropubic midurethral sling.
MEASUREMENTS AND MAIN RESULTS
Patients were given a diary of pain scales and asked to record their level of pain using the provided visual analog scale scored on a 100-mm Likert scale. Patients recorded their pain 4 hours after hospital discharge and on the night of surgery and their most intense pain each day thereafter for 7 days postoperatively. In addition, patients recorded total opioid and nonsteroidal anti-inflammatory drug consumption daily for 1 week postoperatively. Finally, the quality of recovery was assessed using the Quality of Recovery-15 (QoR-15) questionnaire scores. The median pain score in the experimental group was 20 mm (range, 0-80 mm) versus 30 mm (range, 0-60 mm) in the comparative group (p = .046). The postoperative day 1 QoR-15 scores were significantly lower in the LB group (124 [range, 54-150] vs 144 [range, 68-150], p = .007). There were no significant differences in opioid and nonsteroidal anti-inflammatory drug consumption, the remaining pain scores, or postoperative day 7 QoR-15 scores.
CONCLUSION
The results suggest the use of liposomal bupivacaine during retropubic midurethral sling placement does not provide a clinically significant difference in postoperative day 1 pain scores when compared with immediate-acting bupivacaine hydrochloride and lidocaine.
Topics: Adult; Aged; Analgesics, Opioid; Anesthetics, Local; Bupivacaine; Drug Therapy, Combination; Female; Humans; Lidocaine; Liposomes; Middle Aged; Pain Measurement; Pain, Postoperative; Prosthesis Implantation; Suburethral Slings; Treatment Outcome; Urinary Incontinence
PubMed: 30472302
DOI: 10.1016/j.jmig.2018.11.005 -
Drugs Jul 2021Prolonged-release (PR; as ascribed in the EU) or extended-release (as ascribed in the USA) bupivacaine/meloxicam (HTX-011; hereafter referred to as bupivacaine/meloxicam... (Review)
Review
Prolonged-release (PR; as ascribed in the EU) or extended-release (as ascribed in the USA) bupivacaine/meloxicam (HTX-011; hereafter referred to as bupivacaine/meloxicam PR; Zynrelef) is a synergistic fixed-dose combination (FDC) of the local anaesthetic bupivacaine and the NSAID meloxicam. It is approved in the EU and the USA to treat postoperative pain. After needle-free application at the surgical site, the novel polymer technology allows simultaneous diffusion of bupivacaine and meloxicam over 72 h. In clinical trials, bupivacaine/meloxicam PR significantly reduced postoperative pain and opioid consumption relative to bupivacaine hydrochloride (HCl) and placebo in patients undergoing bunionectomy, herniorrhaphy or total knee arthroplasty (TKA). When used as the foundation of a scheduled non-opioid multimodal analgesia (MMA) regimen, bupivacaine/meloxicam PR further improved pain control and reduced the need for opioids following surgery. Bupivacaine/meloxicam PR was generally well tolerated, with a lower incidence of opioid-related adverse events than bupivacaine HCl and placebo. Although additional data would be beneficial, current evidence indicates that bupivacaine/meloxicam PR is a promising non-opioid treatment option for the management of postoperative pain.
Topics: Analgesics, Opioid; Anesthetics, Local; Anti-Inflammatory Agents, Non-Steroidal; Bupivacaine; Delayed-Action Preparations; Drug Combinations; Drug Interactions; Humans; Meloxicam; Pain, Postoperative
PubMed: 34228280
DOI: 10.1007/s40265-021-01551-9