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Zadrazil M, Marhofer P, Opfermann P, Schmid W, Marhofer D, Zeilberger M, Pracher L, Zeitlinger M. Liposomal Bupivacaine for Peripheral Nerve Blockade: A Randomized, Controlled, Crossover, Triple-blinded Pharmacodynamic Study in Volunteers. Anesthesiology 2024; 141:24-31. [PMID: 38558118 DOI: 10.1097/aln.0000000000004988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND Little is known about the pharmacodynamic characteristics of liposomal bupivacaine. Hypothesizing that they would not identify pharmacodynamic differences from plain bupivacaine during the initial period after administration, but would find better long-term pharmacodynamic characteristics, the authors designed a randomized, controlled, triple-blinded, single-center study in volunteers. METHODS Volunteers aged 18 to 55 yr (body mass index, 18 to 35 kg/m2) received two ulnar nerve blocks under ultrasound guidance. Using a crossover design with a washout phase of 36 days or more, one block was performed with liposomal and one with plain bupivacaine. Which came first was determined by randomization. Sensory data were collected by pinprick testing and motor data by thumb adduction, either way in comparison with the contralateral arm. Endpoints included success, time to onset, and duration of blockade. Residual efficacy was assessed by the volunteers keeping a diary. Statistical analysis included Wilcoxon signed-rank and exact McNemar's tests, as well as a generalized estimation equation model. RESULTS Successful sensory blockade was noted in 8 of 25 volunteers (32%) after liposomal and in 25 of 25 (100%) after plain bupivacaine (P < 0.0001). Significant differences emerged for time to onset, defined as 0% response to pinpricking in four of five hypothenar supply areas (P < 0.0001), and for time from onset to 80% or 20% in one of five areas (P < 0.001; P < 0.001). Carryover effects due to the randomized sequencing were unlikely (estimate, -0.6286; sequence effect, 0.8772; P = 0.474). Self-assessment greater than 3.5 days did reveal, for liposomal bupivacaine only, intermittent but unpredictable episodes of residual sensory blockade. CONCLUSIONS The results show that liposomal bupivacaine is not a suitable "sole" drug for intraoperative regional anesthesia. Findings of its limited long-term efficacy add to existing evidence that a moderate effect, at best, should be expected on postoperative pain therapy. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Markus Zadrazil
- Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Peter Marhofer
- Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Philipp Opfermann
- Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Werner Schmid
- Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Daniela Marhofer
- Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Mira Zeilberger
- Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Lena Pracher
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Markus Zeitlinger
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
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Walls HR, Thomas ES, Kain ZN, Schlechter JA. Does Liposomal Bupivacaine Injectable Suspension Peripheral Nerve Block Further Aid in Decreasing At-home Narcotic Utilization in Children and Adolescents After Anterior Cruciate Ligament Reconstruction. J Pediatr Orthop 2023:01241398-990000000-00319. [PMID: 37400092 DOI: 10.1097/bpo.0000000000002466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
BACKGROUND Opioid misuse and addiction among children and adolescents is an increasingly concerning problem. This study sought to determine whether liposomal bupivacaine injectable suspension admixture administered as a single-shot adductor canal peripheral nerve block (SPNB+BL) would decrease utilization of at-home opioid analgesics after anterior cruciate ligament reconstruction (ACLR) in adolescents compared with single-shot peripheral nerve block with bupivacaine (SPNB+B) alone. METHODS Consecutive ACLR patients with or without meniscal surgery by a single surgeon were enrolled. All received a preoperative single-shot adductor canal peripheral nerve block with either admixture of liposomal bupivacaine injectable suspension with 0.25% bupivacaine (SPNB+BL) or 0.25% bupivacaine alone (SPNB+B). Postoperative pain management included cryotherapy, oral acetaminophen, and ibuprofen. A prescription for 10 doses of hydrocodone/acetaminophen (5/325 mg) was provided in a sealed envelope with instructions to only use in the case of uncontrolled pain. Pain using the visual analog scale; number of consumed narcotics, acetaminophen, ibuprofen, and pain treatment satisfaction for the first 3 postoperative days were recorded. Statistical analysis was performed. RESULTS Fifty-eight patients were enrolled, the average age was 15±1.5 years (SPNB+B=32 patients, SPNB+BL=26 patients). Forty-seven patients (81%) did not require home opioids postoperatively. A significantly lower proportion of patients in the SPNB+BL group required opioids compared with control patients (7.7% vs. 28.1%, P=0.048). Average opioid use was 2 morphine milligram equivalents (MME), 0.4 pills (range, 0 to 20 MME). There were no differences in the visual analog scale or pain treatment satisfaction scores, other demographics, or other operative data. Inverse probability of treatment weighting analysis that was performed to account for any potential group differences revealed home opioid use between groups is significantly different (P<0.001). CONCLUSIONS Liposomal bupivacaine injectable suspension admixture administered as an adductor canal nerve block in adolescents undergoing ACLR effectively reduces home opioid usage postoperatively compared with bupivacaine alone. LEVEL OF EVIDENCE Level II-prospective comparative study.
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Affiliation(s)
- Halle R Walls
- Children's Hospital Orange County
- University of California San Diego School of Medicine, La Jolla
| | - Evelyn S Thomas
- Children's Hospital Orange County
- Kettering Health Dayton, Dayton, OH
| | - Zeev N Kain
- Children's Hospital Orange County
- Department of Anesthesia and Perioperative Care, University of California Irvine School of Medicine
- Center on Stress & Health, University of California, Irvine, CA
| | - John A Schlechter
- Children's Hospital Orange County
- Pediatric Orthopaedic Specialists Orange County, Orange
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Tirotta CF, de Armendi AJ, Horn ND, Hammer GB, Szczodry M, Matuszczak M, Wang NQ, Scranton R, Ballock RT. A multicenter study to evaluate the pharmacokinetics and safety of liposomal bupivacaine for postsurgical analgesia in pediatric patients aged 6 to less than 17 years (PLAY). J Clin Anesth 2021; 75:110503. [PMID: 34534923 DOI: 10.1016/j.jclinane.2021.110503] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/12/2021] [Accepted: 09/03/2021] [Indexed: 10/20/2022]
Abstract
STUDY OBJECTIVE To evaluate the pharmacokinetics and safety of liposomal bupivacaine in pediatric patients undergoing spine or cardiac surgery. DESIGN Multicenter, open-label, phase 3, randomized trial (PLAY; NCT03682302). SETTING Operating room. PATIENTS Two separate age groups were evaluated (age group 1: patients 12 to <17 years undergoing spine surgery; age group 2: patients 6 to <12 years undergoing spine or cardiac surgery). INTERVENTION Randomized allocation of liposomal bupivacaine 4 mg/kg or bupivacaine hydrochloride (HCl) 2 mg/kg via local infiltration at the end of spine surgery (age group 1); liposomal bupivacaine 4 mg/kg via local infiltration at the end of spine or cardiac surgery (age group 2). MEASUREMENTS The primary and secondary objectives were to evaluate the pharmacokinetics (eg, maximum plasma bupivacaine concentrations [Cmax], time to Cmax) and safety of liposomal bupivacaine, respectively. MAIN RESULTS Baseline characteristics were comparable across groups. Mean Cmax after liposomal bupivacaine administration was lower versus bupivacaine HCl in age group 1 (357 vs 564 ng/mL); mean Cmax in age group 2 was 320 and 447 ng/mL for spine and cardiac surgery, respectively. Median time to Cmax of liposomal bupivacaine occurred later with cardiac surgery versus spine surgery (22.7 vs 7.4 h). In age group 1, the incidence of adverse events (AEs) was comparable between liposomal bupivacaine (61% [19/31]) and bupivacaine HCl (73% [22/30]). In age group 2, 100% (5/5) and 31% (9/29) of patients undergoing spine and cardiac surgery experienced AEs, respectively. AEs were generally mild or moderate, with no discontinuations due to AEs or deaths. CONCLUSIONS Plasma bupivacaine levels following local infiltration with liposomal bupivacaine remained below the toxic threshold in adults (~2000-4000 ng/mL) across age groups and procedures. AEs were mild to moderate, supporting the safety of liposomal bupivacaine in pediatric patients undergoing spine or cardiac surgery. Clinical trial number and registry URL: ClinicalTrials.gov identifier: NCT03682302.
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Affiliation(s)
| | - Alberto J de Armendi
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States of America
| | - Nicole D Horn
- Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Gregory B Hammer
- Stanford University School of Medicine, Stanford, CA, United States of America
| | - Michal Szczodry
- Shriners Hospital for Children, Chicago, IL, United States of America
| | - Maria Matuszczak
- University of Texas, McGovern Medical School, Houston, TX, United States of America
| | - Natalie Q Wang
- Pacira BioSciences, Inc., Parsippany, NJ, United States of America
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Cheung BM, Ng PY, Liu Y, Zhou M, Yu V, Yang J, Wang NQ. Pharmacokinetics and safety of liposomal bupivacaine after local infiltration in healthy Chinese adults: a phase 1 study. BMC Anesthesiol 2021; 21:197. [PMID: 34315419 PMCID: PMC8314475 DOI: 10.1186/s12871-021-01407-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 06/17/2021] [Indexed: 11/15/2022] Open
Abstract
Background Liposomal bupivacaine (LB) is a long-acting formulation of bupivacaine. The safety and efficacy of LB has been demonstrated across surgical procedures. However, pharmacokinetic (PK) parameters and safety of LB in the Chinese population have not been assessed. Methods In this single-arm, single center, phase 1, open-label study, PK and safety of local infiltration with LB 266 mg were assessed in healthy Chinese adults. Eligible participants were aged 18 to 55 years with biologic parents and grandparents of Chinese ethnicity, in generally good health (i.e., no clinically significant abnormalities), and with a body mass index (BMI) 19.0 to 24.0 kg/m2 (inclusive) and body weight ≥ 50 kg. Results Participants (N = 20) were predominantly men (80 %); mean age was 32 years; and mean BMI was 21.8 kg/m2. After LB administration, mean plasma levels of bupivacaine rapidly increased during the first hour and continued to increase through 24 h; plasma levels then gradually decreased through 108 h followed by a monoexponential decrease through 312 h. Geometric mean maximum plasma concentration was 170.9 ng/mL; the highest plasma bupivacaine concentration detected in any participant was 374.0 ng/mL. Twenty-two treatment-emergent adverse events were reported (mild, n = 21; moderate, n = 1). Conclusions After single-dose administration of LB, PK measures were similar to a previously reported profile in US adults. The highest observed peak plasma concentration of bupivacaine was several-fold below the plasma concentration threshold accepted as being associated with neurotoxicity or cardiotoxicity (2000–4000 ng/mL). These data support that LB is well tolerated and safe in individuals of Chinese descent. Trial registration NCT04158102 (ClinicalTrials.gov identifier), Date of registration: November 5, 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-021-01407-5.
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Affiliation(s)
- Bernard My Cheung
- Department of Medicine, University of Hong Kong, Queen Mary Hospital Pok Fu Lam, 102 Pok Fu Lam Road, Hong Kong, China.
| | - Pauline Yeung Ng
- Department of Medicine, University of Hong Kong, Queen Mary Hospital Pok Fu Lam, 102 Pok Fu Lam Road, Hong Kong, China.,Department of Adult Intensive Care, Queen Mary Hospital Pok Fu Lam, 102 Pok Fu Lam Road, Hong Kong, China
| | - Ying Liu
- Nuance Biotech Co., Ltd, Room 510, Building 2, CITIC Fortune Plaza, 9 Guangan Road, Fengtai District, Beijing, China
| | - Manman Zhou
- Nuance Biotech Co., Ltd, Room 2106, Ciros Plaza, 388 Nanjing Road W, Huangpu District, Shanghai, China
| | - Vincent Yu
- Pacira BioSciences, Inc., 5 Sylvan Way, Parsippany-Troy Hills, NJ, USA
| | - Julia Yang
- Pacira BioSciences, Inc., Parsippany, NJ, USA.,Present Address: Medical Global Alliance, LLC, 1330 6th Avenue, Manhattan, NY, USA
| | - Natalie Q Wang
- Pacira BioSciences, Inc., 5 Sylvan Way, Parsippany-Troy Hills, NJ, USA
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He Y, Qin L, Huang Y, Ma C. Advances of Nano-Structured Extended-Release Local Anesthetics. NANOSCALE RESEARCH LETTERS 2020; 15:13. [PMID: 31950284 PMCID: PMC6965527 DOI: 10.1186/s11671-019-3241-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 12/26/2019] [Indexed: 05/08/2023]
Abstract
Extended-release local anesthetics (LAs) have drawn increasing attention with their promising role in improving analgesia and reducing adverse events of LAs. Nano-structured carriers such as liposomes and polymersomes optimally meet the demands of/for extended-release, and have been utilized in drug delivery over decades and showed satisfactory results with extended-release. Based on mature technology of liposomes, EXPAREL, the first approved liposomal LA loaded with bupivacaine, has seen its success in an extended-release form. At the same time, polymersomes has advances over liposomes with complementary profiles, which inspires the emergence of hybrid carriers. This article summarized the recent research successes on nano-structured extended-release LAs, of which liposomal and polymeric are mainstream systems. Furthermore, with continual optimization, drug delivery systems carry properties beyond simple transportation, such as specificity and responsiveness. In the near future, we may achieve targeted delivery and controlled-release properties to satisfy various analgesic requirements.
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Affiliation(s)
- Yumiao He
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
- Joint Laboratory of Anesthesia and Pain, Peking Union Medical College, Beijing, 100730, China
- Department of Human Anatomy, Histology and Embryology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, 100005, China
| | - Linan Qin
- Joint Laboratory of Anesthesia and Pain, Peking Union Medical College, Beijing, 100730, China
- Department of Human Anatomy, Histology and Embryology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, 100005, China
| | - Yuguang Huang
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China.
- Joint Laboratory of Anesthesia and Pain, Peking Union Medical College, Beijing, 100730, China.
| | - Chao Ma
- Joint Laboratory of Anesthesia and Pain, Peking Union Medical College, Beijing, 100730, China.
- Department of Human Anatomy, Histology and Embryology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, 100005, China.
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Abstract
Local anesthetics are the only class of drugs that can block transduction and transmission of nociception. Physical properties, mechanism of action, and pharmacokinetics of this class of drugs are reviewed in this article. The clinical use, such intravenous administration of lidocaine, and local and systemic toxic effects are covered. A review of current studies published in the human and veterinary literature on lidocaine patches (Lidoderm) and liposomal bupivacaine (Experal and Nocita) are discussed.
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Liu GL, Bian WC, Zhao P, Sun LH. Delivery of Local Anesthesia: Current Strategies, Safety, and Future Prospects. Curr Drug Metab 2019; 20:533-539. [PMID: 31187706 DOI: 10.2174/1389200220666190610155049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/19/2019] [Accepted: 04/24/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND The systemic administration of anesthesia is associated with severe and undesirable side effects such as sedation, vomiting, nausea, allergies, respiratory problems, and neutrophil dysfunction. With the increase in the procedures of limb surgery, cosmetics, facial, skin, and cancer reconstruction, the demand for local anesthesia has increased multifold during the last one decade. Therefore, novel, safe, and cost-effective methods are being developed to deliver local anesthetics by the surgeons. METHOD To prepare a comprehensive research report on anesthesia, we performed a structured literature search of bibliographic databases for peer-reviewed articles published recently. The studies of different articles were summarized and a deductive qualitative and quantitative data analysis was applied. Subsequently, a comprehensive summary of the analysis was used to frame this review article with ample examples. RESULTS A thorough analysis of the reports suggested that there have been tremendous developments of synthesizing nanoparticle-based local anesthesia drugs. The active targeting ability of nanoparticle-based drug delivery strategy can further help to deliver the desired anesthetic drug locally. It was also found that different local anesthetic drugs are developed into liposome form and show better efficacy in patients receiving anesthesia. CONCLUSION The findings of this review article endorse that safe delivery of anesthesia drugs are essential for the safety of patients. Further, nanotechnology-based strategies are extremely useful for targeted delivery of anesthetic drugs at the required dose without affecting the neighboring tissues.
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Affiliation(s)
- Guo-Liang Liu
- Department of Anesthesiology, The Second Hospital of Jilin University, Changchun 130041, China
| | - Wen-Chao Bian
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun 130041, China
| | - Peng Zhao
- Department of Anesthesiology, The Second Hospital of Jilin University, Changchun 130041, China
| | - Li-Hua Sun
- Department of Anesthesiology, The Second Hospital of Jilin University, Changchun 130041, China
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Hong AJ, Agarwalla A, Liu JN, Gowd AK, McMillan S, Sethi PM, Amin NH. Neurological structures and mediators of pain sensation in anterior cruciate ligament reconstruction. Ann Anat 2019; 225:28-32. [PMID: 31195095 DOI: 10.1016/j.aanat.2019.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/03/2019] [Accepted: 05/28/2019] [Indexed: 02/05/2023]
Abstract
Anterior cruciate ligament (ACL) tears is a devastating injury and one of the most common knee injuries experienced by athletes in the United States. Although patients reach maximal subjective improvement by one-year following ACL reconstruction, many patients often experience moderate to severe post-operative pain. Opioids, intra-articular injections, and regional anesthesia have been previously implemented to mediate post-operative pain. However, chronic opioid usage has become an epidemic in the United States. Alternative analgesic modalities, such as nerve blocks, have been implemented in clinical practice to provide adequate pain relief and minimize opioid usage. Periarticular injections targeted towards local neurological structures performed concomitantly with nerve blocks provides superior pain relief and satisfaction than isolated nerve blocks. Therefore, it is imperative for physicians to understand local neurological anatomy around the knee joint in order to provide adequate analgesia while minimizing opioid consumption. This purpose of this investigation is to summarize (1) neurogenic origins of pain generators and mediators in sites affected by ACL reconstruction and autograft harvest sites and (2) analgesia utilized in ACL reconstruction.
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Affiliation(s)
- Andrew J Hong
- School of Medicine, Loma Linda University, Loma Linda, CA, United States.
| | - Avinesh Agarwalla
- Department of Orthopaedic Surgery, Westchester Medical Center, Valhalla, NY, United States.
| | - Joseph N Liu
- Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, CA, United States.
| | - Anirudh K Gowd
- Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC, United States.
| | - Sean McMillan
- Our Lady of the Lourdes Health System, Burlington, NJ, United States.
| | - Paul M Sethi
- Orthopaedic and Neurosurgery Specialists for Clinical Research and Education, Greenwich, CT, United States.
| | - Nirav H Amin
- Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, CA, United States.
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Marino J, Scuderi G, Dowling O, Farquhar R, Freycinet B, Overdyk F. Periarticular Knee Injection With Liposomal Bupivacaine and Continuous Femoral Nerve Block for Postoperative Pain Management After Total Knee Arthroplasty: A Randomized Controlled Trial. J Arthroplasty 2019; 34:495-500. [PMID: 30583813 DOI: 10.1016/j.arth.2018.11.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 10/29/2018] [Accepted: 11/19/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Local periarticular infiltration (PAI) analgesia has emerged as an important component of multimodal approaches to treat total knee arthroplasty postoperative pain. Liposomal bupivacaine may provide prolonged analgesic duration when injected into the surrounding tissues. The purpose of this study was to compare the analgesic efficacy and serum bupivacaine levels of a continuous femoral nerve block (CFNB) with bupivacaine to PAI with liposomal bupivacaine. METHODS Sixty-five patients undergoing primary unilateral total knee arthroplasty were randomized into 2 groups: (1) CFNB and PAI with bupivacaine (CFNB group) or (2) PAI with bupivacaine:liposomal bupivacaine mixture at the end of surgery (LB group). The primary outcome was pain intensity at maximum knee flexion 24 hours following surgery. Secondary outcomes included pain intensities at rest and movement at timed intervals and serum bupivacaine levels. RESULTS Patients in the CFNB group experienced lower pain scores at maximum knee flexion at 24 hours (7.91; 95% confidence interval, 7.19-8.61) compared to the LB group (8.95; 95% confidence interval, 8.42-9.48; P = .02). The mean peak serum bupivacaine level in the LB group up to 72 hours was 0.55 μg/mL versus 1.4 μg/mL for CFNB group (P = .0008) with one patient in the CFNB group exceeding the reported minimum serum bupivacaine threshold for toxicity. CONCLUSION While similar pain control was observed on the day of surgery for both groups, patients with a CFNB experienced lower pain intensities during maximum knee flexion at 24 hours. Total serum concentrations in LB group remained below the toxicity threshold over the study period.
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Affiliation(s)
- Joseph Marino
- Department of Anesthesiology, Zucker School of Medicine, Long Island Jewish Valley Stream, Valley Stream, NY
| | - Giles Scuderi
- Orthopedic Service Line, Northwell Health, New York, NY
| | - Oonagh Dowling
- Department of Anesthesiology, Zucker School of Medicine, New Hyde Park, NY
| | - Rena Farquhar
- Department of Anesthesiology, Zucker School of Medicine, Northwell Health, Long Island Jewish Valley Stream, Valley Stream NY
| | - Bridget Freycinet
- Department of Anesthesiology, Zucker School of Medicine, Northwell Health, Long Island Jewish Valley Stream, Valley Stream NY
| | - Frank Overdyk
- Department of Anesthesiology, Trident Anesthesiology Group, Charleston, SC
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Coppens SJ, Zawodny Z, Dewinter G, Neyrinck A, Balocco AL, Rex S. In search of the Holy Grail: Poisons and extended release local anesthetics. Best Pract Res Clin Anaesthesiol 2019; 33:3-21. [DOI: 10.1016/j.bpa.2019.03.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 03/12/2019] [Indexed: 11/17/2022]
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Danoff JR, Goel R, Henderson RA, Fraser J, Sharkey PF. Periarticular Ropivacaine Cocktail Is Equivalent to Liposomal Bupivacaine Cocktail in Bilateral Total Knee Arthroplasty. J Arthroplasty 2018; 33:2455-2459. [PMID: 29599033 DOI: 10.1016/j.arth.2018.02.083] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 02/13/2018] [Accepted: 02/20/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND This study compares the effectiveness of 2 commonly used periarticular injection formulations: liposomal bupivacaine and bupivacaine (EXP) and ropivacaine, epinephrine, ketorolac, and clonidine (ROP) in patients undergoing bilateral total knee arthroplasty or unicompartmental knee arthroplasty. METHODS Twenty-six total knee arthroplasty patients (52 knees) and 3 unicompartmental knee arthroplasty patients (6 knees) undergoing simultaneous, bilateral arthroplasty were randomized to receive periarticular injections in a blinded fashion. Even birth year patients were selected for PAI of EXP in the right knee and ROP in the left knee. This was reversed for odd birth years. Visual analog scale pain scores for each knee and patient perceived difference in knee functional recovery were recorded during physical therapy, throughout the hospitalization. RESULTS There was no difference in visual analog scale pain scores between the EXP and ROP injected knees at any time point during the first 2 days after surgery. Postoperative pain scores averaged 41.9 mm (range 0-100 mm) for EXP and 43.1 mm (range 0-100 mm) for ROP. Patients were unable to detect a difference in the functional recovery between their knees on postoperative day 0, 1, or 2. No complications as a result of either periarticular injection occurred. CONCLUSION Periarticular injections of EXP and ROP are equally effective after knee arthroplasty and patients do not appreciate differences between knees as determined by pain score or perceived functional recovery during the first 2 days after bilateral knee arthroplasty. This study demonstrates that a liposomal bupivacaine injection does not add an incremental benefit for pain control compared to a less expensive injection formulation.
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Affiliation(s)
- Jonathan R Danoff
- Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Rahul Goel
- Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - R Andrew Henderson
- Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - James Fraser
- Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Peter F Sharkey
- Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
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