Study Finds Liposomal Bupivacaine Alone Not Sufficient to Control Pain During Surgery Interview with:
Professor Peter Marhofer, MD
Director of Paediatric Anaesthesia
Senior Researcher Paediatric and Regional Anaesthesia
Medical University of Vienna
Department of Anaesthesia, Intensive Care Medicine and Pain Medicine
Vienna, Austria What is the background for this study?

Response: One of the major limitations in the use of local anaesthetics is their limited duration of action. In recent years, liposomal formulations with prolonged release kinetics have been developed with the idea to control the sensation of pain not only during but also after surgery and thus achieving an opioid-sparing effect. In this context “liposomal” means that the active ingredient is encapsulated in vesicles called liposomes, which should enable a slower release over a longer period of time. In our study we included 25 healthy volunteers. The study participants were randomly assigned to receive two nerve blocks with bupivacaine for pain control, one in the conventional and one in the liposomal form. What are the main findings?

Response: As the research showed, the administration of liposomal bupivacaine only completely blocked pain conduction in around a third of the test subjects, compared to 100 per cent after administration of the conventional form. This suggests that liposomal bupivacaine alone is not sufficient to control pain during surgery.

As far as longer-lasting post-operative efficacy is concerned, liposomal bupivacaine did lead to a reduction in pain sensitivity in the affected area of the body that lasted for 3.5 days. However, based on our findings, this effect cannot be regarded as reliable, as the effectiveness was unpredictable even within a single test subject and sometimes decreased and increased again several times over time. What should readers take away from your report?

Response: Our study showed unpredictable effects of liposomal bupivacaine in terms of nerve block and associated pain relief. Based on our findings, the substance cannot currently be recommended for use in pain therapy during and after surgery. What recommendations do you have for future research as a result of this study?

Response: As our findings showed the limited clinical efficacy of liposomal bupivacaine, the continued search for long-acting nerve-blocking substances is therefore a priority. Is there anything else you would like to add?

Response: Obviously, our study was conducted in volunteers who did not undergo surgery, and these trials, which are not associated with surgery, have their drawbacks. Thus, studies comparing sensory testing methods in volunteers with the clinical setting of postoperative analgesia are needed. Therefore, studies in volunteers need to be validated by well-designed clinical trials.

Publication: Anesthesiology

Liposomal Bupivacaine for Peripheral Nerve Blockade: A Randomised, Controlled, Crossover, Triple-Blinded Pharmacodynamic Study in Volunteers
Markus Zadrazil, Peter Marhofer, Philipp Opfermann, Werner Schmid, Daniela Marhofer, Mira Zeilberger, Lena Pracher, Markus Zeitlinger;
DOI: 10.1097/ALN.0000000000004988

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Last Updated on May 15, 2024 by