Abstract
Purpose
Opioid analgesics, the cornerstone of effective postsurgical pain management, may
be associated with risk of opioid-related adverse drug events (ADEs) that may complicate
the postsurgical experience. Perioperative multimodal analgesic regimens have the
potential to improve postsurgical pain control and may permit use of lower analgesic
doses and reduce the incidence of opioid-related ADEs. Utility of traditional local
anesthetic formulations to provide analgesia over the entire postsurgical period is
limited by their short duration of action. Liposome bupivacaine, a liposomal formulation
of bupivacaine indicated for single-dose administration into the surgical site to
produce postsurgical analgesia, was evaluated in multiple surgical models as part
of multimodal analgesic regimens and was found in clinical trials to provide postsurgical
analgesia for up to 72 hours. Here, we provide an overview of the available multimodal
analgesic options and recent recommendations for optimal postsurgical pain management.
Methods
A review of the literature was conducted, and results from recent clinical trials
are included.
Findings
The use of a multimodal analgesic regimen, including liposome bupivacaine, can extend
the time to first postsurgical opioid use, may reduce postsurgical opioid consumption,
and reduce hospital length of stay and costs compared with an opioid-only analgesic
regimen.
Implications
Use of multimodal analgesic regimens is a practical way to achieve good postsurgical
analgesia while minimizing reliance on opioids and associated adverse events. Taken
as a whole, evidence from the clinical studies of liposome bupivacaine suggests this
local anesthetic formulation may be a useful component of multimodal analgesic regimens
for managing postsurgical pain in select patients, with the potential to reduce opioid
use and opioid-related ADEs in the postsurgical setting. As with bupivacaine, appropriate
use of liposome bupivacaine to optimize clinical effects, economic implications, and
patient tolerability will depend on appropriate patient selection, practitioner training,
and institutional protocols. As a component of a multimodal analgesic regimen, liposome
bupivacaine represents a new approach to extending the duration of postsurgical analgesia.
Further studies across a range of surgical settings should help clarify the most appropriate
roles for this prolonged-release formulation of bupivacaine.
Key words
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Article info
Publication history
Published online: April 10, 2015
Accepted:
March 11,
2015
Identification
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© 2015 Elsevier HS Journals, Inc. Published by Elsevier Inc. All rights reserved.
