Liposomal Bupivacaine Versus Bupivacaine with Adjunct Medications in Upper Extremity Single Shot Peripheral Nerve Blocks: An Integrative Review

Hannah Wairagu, RN, DNP, CRNA

DNP Nurse Anesthesia 

Liposomal Bupivacaine Versus Bupivacaine with Adjunct Medications in Upper Extremity Single Shot Peripheral Nerve Blocks: An Integrative Review 

Project Category: Evidence Synthesis 

Project Team: Hannah Wairagu, DNP, CRNA Ginna Kim, CRNA, DNP (Advisor)

Abstract

Background: Regional anesthesia has been advocated as a method to reduce postoperative pain and to reduce opioid dependence.  However, local anesthetics used in regional anesthesia may have a limited duration of action.  To prolong their duration other adjuncts, such as dexamethasone, dexmedetomidine, and clonidine can be added to local anesthetics. It has been proposed that liposomal bupivacaine can provide a prolonged duration of action. Thus, an integrative review was done to assess how liposomal bupivacaine compares with other commonly used adjuncts to plain bupivacaine in upper extremity regional blocks.

Methods: A systematic search of PubMed, Ovid Medline, Cochrane Library (CINAHL), Google Scholar, and the US clinical trials register was performed. Liposomal bupivacaine combined with plain bupivacaine was compared with plain bupivacaine or plain bupivacaine combined with an adjunct used in a single shot upper extremity regional block. Articles were appraised for risk of bias using the Joanna Briggs appraisal tools.

Results: A total of nine randomized control trials containing 875 patients were included in this review.  Five studies reported lower opioid consumption when liposomal bupivacaine was combined with plain bupivacaine. Four studies did not record any significant differences in opioid usage, and six out of nine studies reported lower pain scores with liposomal bupivacaine at certain intervals ranging from post-operative day one to day four.

Conclusion: Overall, liposomal bupivacaine is an effective adjunct in lowering pain scores after upper extremity surgeries. However, there are conflicting results on the effectiveness of liposomal bupivacaine in reducing opioid usage when compared to currently used adjuncts. 

Full Manuscript Slide Presentation Video