lunes, 7 de julio de 2014

Bupivacaína liposomal/.Liposomal bupivacaine

Bupivacaína liposomal: revisión de una nueva formulación de bupivacaína


Liposomal bupivacaine: a review of a new bupivacaine formulation.
Chahar P, Cummings KC 3rd.
J Pain Res. 2012;5:257-64
Abstract
Many attempts have been made to increase the duration of local anesthetic action. One avenue of investigation has focused on encapsulating local anesthetics within carrier molecules to increase their residence time at the site of action. This article aims to review the literature surrounding the recently approved formulation of bupivacaine, which consists of bupivacaine loaded in multivesicular liposomes. This preparation increases the duration of local anesthetic action by slow release from the liposome and delays the peak plasma concentration when compared to plain bupivacaineadministration. Liposomal bupivacaine has been approved by the US Food and Drug Administration for local infiltration for pain relief after bunionectomy and hemorrhoidectomy. Studies have shown it to be an effective tool for postoperative pain relief with opioid sparing effects and it has also been found to have an acceptable adverse effect profile. Its kinetics are favorable even in patients with moderate hepatic impairment, and it has been found not to delay wound healing after orthopedic surgery. More studies are needed to establish its safety and efficacy for use via intrathecal, epidural, or perineural routes. In conclusion, liposomal bupivacaine is effective for treating postoperative pain when used via local infiltration when compared to placebo with a prolonged duration of action, predictable kinetics, and an acceptable side effect profile. However, more adequately powered trials are needed to establish its superiority over plain bupivacaine.
KEYWORDS:efficacy; liposomal bupivacaine; pharmacodynamics; pharmacokinetics; postoperative pain; safety
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3442744/pdf/jpr-5-257.pdf



Tratamiento de isquemia digital con bupivacaína liposomal


Treatment of digital ischemia with liposomal bupivacaine.
Raul Soberón J, Duncan SF, Sternbergh WC.

Case Rep Anesthesiol. 2014;2014:853243.

Abstract

Objective. This report describes a case in which the off-label use of liposomal bupivacaine (Exparel) in a peripheral nerve block resulted in marked improvement of a patient's vasoocclusive symptoms. The vasodilating and analgesic properties of liposomal bupivacaine in patients with ischemic symptoms are unknown, but our clinical experience suggests a role in the management of patients suffering from vasoocclusive disease. Case Report. A 45-year-old African American female was admitted to the hospital with severe digital ischemic pain. She was not a candidate for any vascular surgical or procedural interventions. Two continuous supraclavicular nerve blocks were placed with modest clinical improvement. These effects were also short-lived, with the benefits resolving after the discontinuation of the peripheral nerve blocks. She continued to report severe pain and was on multiple anticoagulant medications, so a decision was made to perform an axillary nerve block using liposomal bupivacaine (Exparel) given the compressibility of the site as well as the superficial nature of the target structures. Conclusions. This case report describes the successful off-label usage of liposomal bupivacaine (Exparel) in a patient with digital ischemia. Liposomal bupivacaine (Exparel) is currently FDA approved only for wound infiltration use at this time.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3933553/pdf/CRIM.ANESTHESIOLOGY2014-853243.pdf






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Anestesiología y Medicina del Dolor
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