Epidural administration of liposome-associated bupivacaine for the management of postsurgical pain: a first study

To explore the influence of liposomes on the pharmacodynamic action of bupivacaine and to determine whether postsurgical analgesic advantages can be obtained from epidural delivery of liposomal bupivacaine compared with the current formulation. Open, nonrandomized study. Physiopathology laboratory,...

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Bibliographic Details
Published in:	Journal of clinical anesthesia Vol. 6; no. 4; p. 315
Main Authors:	Boogaerts, J G, Lafont, N D, Declercq, A G, Luo, H C, Gravet, E T, Bianchi, J A, Legros, F J
Format:	Journal Article
Language:	English
Published:	United States 01-07-1994
Subjects:	Aged Analgesia, Epidural Aorta, Abdominal - surgery Autonomic Nerve Block Bupivacaine - administration & dosage Bupivacaine - pharmacology Drug Carriers Humans Hypotension - etiology Liposomes Middle Aged Nerve Block Neurons, Afferent - drug effects Pain, Postoperative - prevention & control Skin Temperature - drug effects Time Factors
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Summary:	To explore the influence of liposomes on the pharmacodynamic action of bupivacaine and to determine whether postsurgical analgesic advantages can be obtained from epidural delivery of liposomal bupivacaine compared with the current formulation. Open, nonrandomized study. Physiopathology laboratory, general operating theaters, and intensive care units of Reine Fabiola Hospital and Institut Médical de Traumatologie et Revalidation. 26 ASA physical status II and III patients who had undergone major surgery (abdominal, vascular, urologic, thoracic, orthopedic). After completion of the operation, the patients were divided into 2 groups to receive 1 of 2 bupivacaine preparations epidurally for postsurgical pain: Group 1 (n = 12) received plain 0.5% bupivacaine with 1:200,000 epinephrine; Group 2 (n = 14) received liposomal 0.5% bupivacaine. The following observations were made: onset and quality of analgesia, quality of motor block according to the Bromage scale, and sympathetic block. Onset time of sensory block averaged 15 minutes in both groups. Pain relief durations were 3.2 +/- 0.4 hours with plain bupivacaine and 6.25 +/- 1.13 hours with the liposomal preparation (p < 0.05). In the liposomal bupivacaine group, no motor block was recorded. Low sympathetic block occurred in all patients. Analgesia in a subset of patients following abdominal aortic surgery increased from 2.4 +/- 0.35 hours to 10.6 +/- 1.4 hours by encapsulation of bupivacaine (p < 0.01). There was no neurotoxicity or cardiotoxicity. The liposomal formulation of bupivacaine increased duration of analgesia without motor block or adverse side effects.
ISSN:	0952-8180
DOI:	10.1016/0952-8180(94)90079-5