By Nancy A. Melville
The extended-release local anaesthetic liposomal bupivacaine, commonly used in various surgical sites in adults, shows safety and efficacy in children and adults alike for control of pain with neurosurgery, according to a study presented here at the 2019 Annual Meeting of the American Association of Neurological Surgeons (AANS).
“Our findings show liposomal bupivacaine was not associated with any adverse events and may play an important role in the management of postoperative neurosurgical pain,” said David Rafael Santiago-Dieppa, MD, University of California at San Diego, San Diego, California.
Liposomal bupivacaine, an extended release amide local anaesthetic has been shown to provide local anaesthesia for up to 96 hours.
Studies have been lacking on the safety of the drug in children undergoing neurosurgery, or in craniotomies or other intradural procedures.
For the pilot study, Dr. Santago-Dieppa and his colleagues at Rady Children’s Hospital in San Diego used liposomal bupivacaine as surgical site infiltration in 14 patients aged 2 to 26 years.
Liposomal bupivacaine was administered in a dose of 0.3 ml/kg (13.3 mg/ml) and admixed with an additional 0.6 ml/kg of plain 0.25% bupivacaine.
For cases of durotomy, liposomal bupivacaine was injected prior to the incision ensure no leaching or contact with the central nervous system.
The neurosurgeries being performed included supratentorial craniotomy (n = 2), spinal cord tumour (n = 2), chiari decompression (n = 4), tethered cord release (n = 3), and lumbar decompression and/or instrumented fusion (n = 3).
There were no neurologic, cardiovascular, respiratory, or allergic events observed.
“We are currently preparing for a larger randomised prospective trial in order to further evaluate the safety and efficacy of this drug in the neurosurgical population,” said Dr. Santiago-Dieppa.
[Presentation title: Pilot Safety Trial of Extended Release Liposomal Buvipacaine (Exparel) for Postoperative Analgesia in the Adult and Pediatric Neurosurgical Population. Abstract 309]