Liposomal Bupivacaine: Dr. Vandepitte’s Test Criteria
Dr. Vandepitte staged a special study to determine “the safety and efficacy of adding liposomal bupivacaine (Exparel, Pacira)” to the current protocol.”
Any study must establish criteria, so let’s investigate Dr. Vanpitte’s list:
1. The research was designed as a randomized, double-blind study.
2. Eligible patients were between 18 and 90 years old. They met the
American Society of Anesthesiologists physical status I to III. For this research, 50 orthopedic patients with arthroscopic shoulder surgeries slated, were selected.
3. Status Quo: The orthopedic surgery patients were given “a single-shot interscalene brachial plexus block as part of their multimodal analgesia protocol.”
A Special Note on the Interscalene Technique
This technique was a perfect choice for the upper arm and shoulder nerve block. “The interscalene technique is ideal for coverage of the lateral 2/3 of the clavicle…the shoulder…and the proximal humerus.” Our advanced readers should note that “…when arthroscopic surgery is undertaken, the posterior arthroscopic port may require additional infiltration.”
You can learn more about the interscalene technique at the online resource of
Open Anesthesia.Org.
Dr. Vandepitte’s Methods of Measurement for the Performance of Liposomal Bupivacaine :
The pain-relieving data was recorded for the first 7 days after surgery. Analysis was charted according to two measuring tools:
The Modified Brief Pain Inventory (short form)
The Overall Benefit of Analgesia Score
Dr. Vandepitte acknowledged in advance that extensive surgeries such as total shoulder replacement or rotator cuff repair could require an interscalene brachial plexus catheter. (See more about the pain relieving catheter, as you continue reading.)
The Research Procedure
The 50 patients included in the study were randomly assigned to receive either one of two treatments:
Research like Dr. vandepitte’s Liposomal Bupivaciane study help anesthesiologists defeat post-op pain before it starts.
A. The interscalene brachial plexus block with 15 mL of bupivacaine 0.25% or
B. The interscalene brachial plexus block with “a mixture of liposomal bupivacaine and bupivacaine 0.25%. “
Additionally, all patients received general anesthesia. Any “opioids during the study period were short-acting (i.e., remifentanil in combination with propofol).”
Dr. Vandepitte explained, “The problem [with] interscalene brachial plexus single-shots is the amount of time of analgesia is limited to up to 12 to 14 hours.”
Previous to Dr. Vandepitte’s research, the answer to this problem was to place catheters to help extend the analgesia.
The catheters could extend the time for effective analgesia, but they had drawbacks: They required cautious and time-consuming expertise for placement. Complications could ensue if the pain-relieving
catheters became dislocated.
Last but not least, some patients also were uncomfortable or anxious with the idea of being sent home with a pain relieving catheter in place.
Dr. Vandepitte stated, “Our hypothesis was that if we could add liposomal bupivacaine as an additive to bupivacaine, we could extend the analgesia time in a way that patients would be much more comfortable, going home earlier and not needing catheters.”
Dr. Vandepitte’s Conclusions
When the results were tabulated, the researchers were pleased.
“We found that the addition of liposomal bupivacaine resulted in lower pain thresholds up to seven days postoperatively,” Dr. Vandepitte announced.
Her data backed up her desired conclusion:
1. Worst pain scores on postoperative day 1 were 2.2±2.8 for the liposomal bupivacaine mixture group and 4.0±3.5 for the bupivacaine-only group.
2. Worst pain scores on postoperative day 7 were 4.2±2.6 for the liposomal bupivacaine mixture and but the bupivacaine-only group scored 5.2±2.4,
3.
It must be mentioned that liposomal bupivacaine is currently not approved for peripheral blocks. The team conducted this research only after receiving several approvals, not the least of which was from the ethics committee.
Throughout the study, the researchers were also on the look-out for respiratory problems from diaphragmatic paralysis. Fortunately there were no “prolonged motor blockade or respiratory problems” in either study group.
You might have noticed this was a very small study. Dr. Vandepitte is well aware there is much more work to be done in this area. Future studies will include “determining the ideal dose of liposomal bupivacaine to administer for interscalene brachial plexus blocks.”
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