Liposomal bupivacaine and clinical outcomes

• Published in: Best practice & research. Clinical anaesthesiology 2014-03, Vol.28 (1), p.15-27
• Main Authors: Tong, Yi Cai Isaac, MD, Kaye, Alan David, MD, PhD, Urman, Richard D., MD, MBA, CPE
• Format: Article
• Language: English
• Subjects: adult anesthetics; Anesthesia & Perioperative Care; local/administration and dosage anesthetics; local/adverse effects anesthetics; local/therapeutic use bupivacaine/administration and dosage bupivacaine/adverse effects bupivacaine/therapeutic use
• ISSN: 1521-6896; 1532-169X
• DOI: 10.1016/j.bpa.2014.02.001

In the multimodal approach to the management of postoperative pain, local infiltration and regional blocks have been increasingly utilized for pain control. One of the limitations of local anesthetics in the postoperative setting is its relatively short duration of action. Multivesicular liposomes containing bupivacaine have been increasingly utilized for their increased duration of action. Compared with bupivacaine HCl, local infiltration of liposomal bupivacaine has shown to have an increase in duration of action and causes delay in peak plasma concentration. In this article, we attempt to review the clinical literature surrounding liposomal bupivacaine and its evolving role in perioperative analgesia. This new bupivacaine formation may have promising implications in postoperative pain control, resulting in increased patient satisfaction and a decrease in both hospital stay and opioid-induced adverse events (AEs). Although more studies are needed, the preliminary clinical trials suggest that liposomal bupivacaine has predictable pharmacokinetics, a similar side effect profile compared with bupivacaine HCl, and is effective in providing increased postoperative pain control.