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International Journal of Anesthesiology & Pain Medicine
ISSN: 2471-982X
Volume 4
March 26-28, 2018
Vienna, Austria
Pain Management 2018
Internal Medicine 2018
Page 38
JOINT EVENT
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E d i t i o n o f I n t e r n a t i o n a l C o n f e r e n c e o n
Internal Medicine and Patient Care
&
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t h
E d i t i o n o f I n t e r n a t i o n a l C o n f e r e n c e o n
Pain Management
P
ost-operative pain control continues to be a problem in
surgical patients. A novel formulation of an ultra-long acting
local anesthetic is now available in the US: Exparel or liposomal
bupivacaine. Liposomal bupivacaine is made up of microscopic
polyhedral particles. The liposomes encapsulate the drug,
bupivacaine hydrochloride, without altering molecular structure.
This provides the reliable low dose release of the bupivacaine
over time, providing long-lasting, post-surgical pain relief over
the course of 2-3 days. This eliminates the need for titration of a
single dose or the need for external devices or pumps to prolong
analgesia.Plasmabupivacainelevelsmaypersistfor96hoursafter
injection. Peak plasma concentrations are lower inmagnitude and
occur later in time than after a similar injection with bupivacaine
HCl. Plasma bupivacaine concentrations are not correlated with
local efficacy. Safety profile was evaluated in 10 clinical trials
in patients undergoing a variety of surgical procedures. Most
common adverse events were nausea, constipation and vomiting.
Exparel demonstrated a favorable cardiac profile. There was no
cardiac toxicity and no QTc prolongation, even a supra-therapeutic
dose. Rate of absorption is dependent on total dose administered,
route of administration and vascularity of the surgical site. Efficacy
has been established. Multiple trials demonstrated a significant
reduction in pain intensity scores and a reduction in overall opioid
consumption as compared to placebo. Liposomal bupivacaine is a
safe and effective novel drug to treat post-surgical pain.
Recent Publications
1. Bramlett K, Onel E, Viscusi E R, Jones K (2012)
A randomized, double-blind, dose-ranging study
comparingwound infiltrationofDepoFoambupivacaine,
an extended-release liposomal bupivacaine, to
bupivacaine HCl for postsurgical analgesia in total knee
arthroplasty. Knee. 19(5):530-536.
2. Bergese S D, Onel E, Morren M, Morganroth J (2012)
Bupivacaine extended-release liposome injection
exhibits a favorable cardiac safety profile. Reg Anesth
Pain Med. 37(2):145-151.
3. Naseem A, Harada T, Wang D, et al. (2012) Bupivacaine
extended release liposome injection does not prolong
QTc interval in a thorough QT/QTc study in healthy
volunteers. J Clin Pharmacol. 52(9):1441-1447.
4. Gorfine S R, Onel E, Patou G, Krivokapic Z V (2011)
Bupivacaine extended-release liposome injection for
prolongedpostsurgicalanalgesiainpatientsundergoing
hemorrhoidectomy: a multicenter, randomized, double-
blind, placebo-controlled trial. Dis Colon Rectum.
54(12):1552-1559.
5. GolfM, DanielsSE, Onel E (2011)Aphase3, randomized,
placebo-controlled trial of DepoFoam®bupivacaine
(extended-release bupivacaine local analgesic) in
bunionectomy. Adv Ther. 28(9):776-788.
Biography
Christopher F Tirotta has been an active Member of Miami Children’s Hospital
medical staff since 1991, practicing with the Department of Anesthesiology;
he has served as the Director of Cardiac Anesthesia since 2002. He has served
as Chief of the Department of Anesthesia since July 2017. He also has a clin-
ical appointment with the Department of Anesthesiology at The University of
Miami School of Medicine. He received his BA fromCornell University (USA) in
1982 and his MD fromNew York University School of Medicine (USA) in 1986.
He also received an MBA degree from Columbia University in 1999. He com-
pleted his internship in Internal Medicine at State University of NewYork, Stony
Brook in 1987. He completed his residency training in Anesthesiology at the
University of Miami/Jackson Memorial Hospital in 1990; he sub-specialized in
pediatric and cardiovascular anesthesia, including heart transplantation.
christirotta@att.netLiposomal bupivacaine: a novel, long acting
local anesthetic
Christopher F Tirotta
Nicklaus Children’s Hospital, USA
Christopher F Tirotta, Int J Anesth Pain Med 2018, Volume 4
DOI: 10.21767/2471-982X-C1-001