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Evaluation of DepoFoam® bupivacaine for the treatment of postsurgical pain

Practice Points

Sergio D Bergese†1, Erol Onel2 & Juan Portillo1 „„ Place in postsurgical pain management: DepoFoam® bupivacaine, as the foundation of a multimodal

regimen, may improve acute postsurgical analgesia while reducing the risks of opioid-related adverse events (AEs) and the costs associated with treating those AEs. Available clinical data demonstrate that DepoFoam bupivacaine provides extended duration of analgesic effects, decreases the proportion of patients requiring opioid rescue medications, delays the time to first use of opioid rescue medication, and reduces the total amount of opioids consumed. „„ Inpatient application: DepoFoam bupivacaine may reduce the need for patient-controlled analgesia

devices, catheters, medication pumps and IV poles, therefore increasing patient mobility. Additionally, decreased utilization of opioids would lead to decreased nursing time spent monitoring patients for opioid-related AEs. „„ Outpatient application: In clinical trials, DepoFoam bupivacaine has demonstrated sustained analgesia

for 24–96 h. In addition, DepoFoam bupivacaine offers a convenient mode of administration that does not involve devices or fanny packs, which limit patient mobility. „„ Dosing: Available clinical trial reports indicate that DepoFoam bupivacaine, administered as a single dose

(minimal possible concentrations: 120 mg/8 ml, 300 mg/20 ml, 600 mg/40 ml; diluted to desired volume) infiltrated into the incisional site at the conclusion of a surgical procedure, is an effective component of acute postsurgical multimodal pain management. „„ Ease of use: DepoFoam bupivacaine is administered directly into tissue within the incisional site using a

fine-gauge needle at the conclusion of the surgical procedure. The infiltration process is the same as with bupivacaine HCl and is not altered. „„ Time course of efficacy: A single dose of DepoFoam bupivacaine has been demonstrated to exert local

analgesic effects for up to 3–4 days postsurgically, thereby potentially lessening the need for postsurgical opioid therapy.

Departments of Anesthesiology & Neurological Surgery, Ohio State University Medical Center, 410 W 10th Ave, N411 Doan Hall, Columbus, OH, USA 2 Pacira Pharmaceuticals, Inc., Parsippany, NJ, USA † Author for correspondence: Tel.: +1 614 293 9027; Fax: +1 614 293 8153; [email protected] 1

10.2217/PMT.11.62 © 2011 Future Medicine Ltd

Pain Manage. (2011) 1(6), 539–547

ISSN 1758-1869

539

Practice Points

Review  Bergese, Onel & Portillo „„ Safety and tolerability profile: The safety profile of DepoFoam bupivacaine appears to be similar to that

of bupivacaine HCl. As with any form of bupivacaine, elevated plasma levels may be associated with CNS and cardiac AEs. Caution should be exercised when using DepoFoam bupivacaine in patients with severe hepatic impairment or known cardiovascular disease. DepoFoam bupivacaine has not been studied in patients 

Evaluation of DepoFoam(®) bupivacaine for the treatment of postsurgical pain.

SUMMARY An extended-release, multivesicular liposome-encapsulated form of the local anesthetic bupivacaine, DepoFoam(®) bupivacaine (proposed propriet...
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