Clinical Effectiveness of Liposomal Bupivacaine Administered by Infiltration or Peripheral Nerve Block to Treat Postoperative Pain

2020 ◽  
Author(s):  
Brian M. Ilfeld ◽  
James C. Eisenach ◽  
Rodney A. Gabriel
Keyword(s):  
Postoperative Pain ◽  
Peripheral Nerve ◽  
Nerve Block ◽  
Primary Outcome ◽  
Peripheral Nerve Block ◽  
Clinical Effectiveness ◽  
Primary Outcome Measure ◽  
Nerve Blocks ◽  
Liposomal Bupivacaine ◽  
Randomized Controlled

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.

scholarly journals Liposomal bupivacaine peripheral nerve block for the management of postoperative pain

2015 ◽  
Author(s):  
Thomas W Hamilton ◽  
Vassilis Athanassoglou ◽  
Marialena Trivella ◽  
Stephen Mellon ◽  
David Murray ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Peripheral Nerve ◽  
Nerve Block ◽  
Peripheral Nerve Block ◽  
Liposomal Bupivacaine

scholarly journals Liposomal bupivacaine peripheral nerve block for the management of postoperative pain

2016 ◽  
Author(s):  
Thomas W Hamilton ◽  
Vassilis Athanassoglou ◽  
Marialena Trivella ◽  
Louise H H Strickland ◽  
Stephen Mellon ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Peripheral Nerve ◽  
Nerve Block ◽  
Peripheral Nerve Block ◽  
Liposomal Bupivacaine

scholarly journals Perineural Liposomal Bupivacaine Is Not Superior to Nonliposomal Bupivacaine for Peripheral Nerve Block Analgesia

2020 ◽  
Author(s):  
Nasir Hussain ◽  
Richard Brull ◽  
Brendan Sheehy ◽  
Michael K. Essandoh ◽  
David L. Stahl ◽  
...  
Keyword(s):  
Side Effects ◽  
Peripheral Nerve ◽  
Nerve Block ◽  
Local Anesthetics ◽  
Peripheral Nerve Block ◽  
Length Of Hospital Stay ◽  
Nerve Blocks ◽  
Liposomal Bupivacaine ◽  
Pain Scores ◽  
The Difference

Background Liposomal bupivacaine is purported to extend analgesia of peripheral nerve blocks when administered perineurally. However, evidence of the clinical effectiveness of perineural liposomal bupivacaine is mixed. This meta-analysis seeks to evaluate the effectiveness of perineural liposomal bupivacaine in improving peripheral nerve block analgesia as compared with nonliposomal local anesthetics. Methods The authors identified randomized trials evaluating the effectiveness of peripheral nerve block analgesic that compared liposomal bupivacaine with nonliposomal local anesthetics. The primary outcome was the difference in area under the receiver operating characteristics curve (AUC) of the pooled 24- to 72-h rest pain severity scores. Secondary outcomes included postoperative analgesic consumption, time to first analgesic request, incidence of opioid-related side effects, patient satisfaction, length of hospital stay, liposomal bupivacaine side effects, and functional recovery. AUC pain scores were interpreted in light of a minimal clinically important difference of 2.0 cm · h. Results Nine trials (619 patients) were analyzed. When all trials were pooled, AUC pain scores ± SD at 24 to 72 h were 7.6 ± 4.9 cm · h and 6.6 ± 4.6 cm · h for nonliposomal and liposomal bupivacaine, respectively. As such, perineural liposomal bupivacaine provided a clinically unimportant benefit by improving the AUC (95% CI) of 24- to 72-h pain scores by 1.0 cm · h (0.5 to 1.6; P = 0.003) compared with nonliposomal bupivacaine. Excluding an industry-sponsored trial rendered the difference between the groups nonsignificant (0.7 cm · h [−0.1 to 1.5]; P = 0.100). Secondary outcome analysis did not uncover any additional benefits to liposomal bupivacaine in pain severity at individual timepoints up to 72 h, analgesic consumption, time to first analgesic request, opioid-related side effects, patient satisfaction, length of hospital stay, and functional recovery. No liposomal bupivacaine side effects were reported. Conclusions Perineural liposomal bupivacaine provided a statistically significant but clinically unimportant improvement in the AUC of postoperative pain scores compared with plain local anesthetic. Furthermore, this benefit was rendered nonsignificant after excluding an industry-sponsored trial, and liposomal bupivacaine was found to be not different from plain local anesthetics for postoperative pain and all other analgesic and functional outcomes. High-quality evidence does not support the use of perineural liposomal bupivacaine over nonliposomal bupivacaine for peripheral nerve blocks. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Postoperative Pain Management for Peripheral Nerve Block Patients

2011 ◽  
Vol 26 (3) ◽  
pp. 188
Author(s):  
Pamela Windle ◽  
Agnes Hsu ◽  
Thomas Prodan ◽  
Videlyn Ilacio-Uy ◽  
Herminia Robles
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Peripheral Nerve ◽  
Nerve Block ◽  
Peripheral Nerve Block ◽  
Postoperative Pain Management

Time Sequence of Sensory Changes after Upper Extremity Block

2004 ◽  
Vol 101 (1) ◽  
pp. 162-168 ◽  
Author(s):  
Xavier Paqueron ◽  
Marc E. Gentili ◽  
Jean Claude Willer ◽  
Pierre Coriat ◽  
Bruno Riou
Keyword(s):  
Peripheral Nerve ◽  
Nerve Block ◽  
Peripheral Nerve Block ◽  
Clinical Test ◽  
Sensory Impairment ◽  
Sensory Testing ◽  
Early Assessment ◽  
Sensory Assessment ◽  
Nerve Blocks ◽  
Sensory Fibers

Background Sensory assessment to estimate spread and effectiveness of a peripheral nerve block is difficult because no clinical test is specific for small sensory fibers. Occurrence of a swelling illusion (SI) during a peripheral nerve block corresponds to the impairment of small sensory fibers. The authors investigated the usefulness of SI in predicting successful peripheral nerve block by assessing the temporospatial correlation between progression of sensory impairment in cutaneous distributions anesthetized and localization of SI during peripheral nerve block installation. Methods Interscalene, infracoracoid, or sciatic nerve blocks were performed using a nerve stimulator and 1.5% mepivacaine in 53 patients, with a total of 201 nerves to be anesthetized. Pinprick, cold, warm, touch, and proprioception were assessed every 3 min, while patients were asked to describe their perception of size and shape of their anesthetized limb and localization of these illusions. Data are presented as mean +/- SD and percentage (95% confidence interval). Results Failure occurred in 12 cutaneous distributions out of a total of 201 theoretically blocked nerves. SI appeared earlier than warmth impairment (4.3 +/- 2.7 vs. 6.2 +/- 2.0 min; P < 0.05), always corresponding to successfully anesthetized cutaneous distributions, with the exception of 1 patient, who developed SI in 2 cutaneous distributions while sensory testing indicated failure in 1 distribution. SI successfully predicted the blockade of a cutaneous distribution with a sensitivity of 1.00 (0.98-1.00), a specificity of 0.92 (0.65-0.99), and an accuracy of 0.99 (0.97-1.00). Conclusions Swelling illusion may provide an early assessment of the success of a peripheral nerve block in unsedated patients.

Liposomal Bupivacaine as a Single-Injection Peripheral Nerve Block

2014 ◽  
Vol 58 (3) ◽  
pp. 145-146
Author(s):  
Brian M. Ilfeld ◽  
Nisha Malhotra ◽  
Timothy J. Furnish ◽  
Michael C. Donohue ◽  
Sarah J. Madison
Keyword(s):  
Peripheral Nerve ◽  
Nerve Block ◽  
Peripheral Nerve Block ◽  
Single Injection ◽  
Liposomal Bupivacaine

Greater occipital nerve block in migraine prophylaxis: Narrative review

Cephalalgia ◽  
2019 ◽  
Vol 39 (7) ◽  
pp. 908-920 ◽  
Author(s):  
Levent Ertugrul Inan ◽  
Nurten Inan ◽  
Hanzade Aybuke Unal-Artık ◽  
Ceyla Atac ◽  
Gulcin Babaoglu
Keyword(s):  
Peripheral Nerve ◽  
Nerve Block ◽  
Peripheral Nerve Block ◽  
Case Reports ◽  
Migraine Treatment ◽  
Occipital Nerve ◽  
Randomized Controlled ◽  
Greater Occipital Nerve Block ◽  
Greater Occipital Nerve ◽  
Occipital Nerve Block

Objectives The importance and popularity of peripheral nerve block procedures have increased in the treatment of migraine. Greater occipital nerve (GON) block is a commonly used peripheral nerve block method, and there are numerous researches on its use in migraine treatment. Materials and methods A search of PubMed for English-language randomized controlled trials (RCT) and open studies on greater occipital nerve block between 1995 and 2018 was performed using greater occipital nerve, headache, and migraine as keywords. Results In total, 242 potentially relevant PubMed studies were found. A sum of 228 of them which were non-English articles and reviews, case reports, letters and meta-analyses were excluded. The remaining articles were reviewed, and 14 clinical trials, seven of which were randomized-controlled on greater occipital nerve block in migraine patients, were identified and reviewed. Conclusions Although clinicians commonly use greater occipital nerve block in migraine patients, the procedure has yet to be standardized. The present study reviewed the techniques, drugs and dosages, the frequency of administration, side effects, and efficacy of greater occipital nerve block in migraine patients.

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