Bupivacaine Liposome

Bupivacaine liposome is a local anesthetic used as an analgesic to numb pain after surgery.

Overview

Bupivacaine liposome, known as an anesthetic to relieve pain after surgery, blocks nerve impulses in the body that send pain signals to the brain. Ordinarily, most patients report moderate to severe pain within 24 to 72 hours after surgery. This analgesic is used to numb an area of the body for minor surgery, such as a removal of a bunion or hemorrhoid, but may also include procedures in general, orthopedic or oral surgeries. As an injection, the bupivacaine is inserted near a surgical incision to reduce a significant amount of pain while given in a single dose.

This medication, injected into the soft tissue at the surgical site, should cause numbness specifically to the area where the injection took place and may create a temporary loss of sensation to the location. The patient should not fall asleep or become unconscious as a result of this injection; nevertheless, your physician will monitor your condition carefully as a result of this treatment.

As the brand name Exparel, it is a germ-free, preservative-free suspension of liposome that releases bupivacaine into soft tissue over a period of time following an injection, thus providing the patient with relief. Exparel, once administered into the surgical site, produces postsurgical analgesia to the patient and not as an anesthetic in this context.

Local anesthetics, including bupivacaine, can distribute this medication, to some extent, to all body tissues with high concentrations found in organs such as the liver, lungs, heart and brain. The absorption rate is dependent upon the total dose of the drug. Any patient with liver, kidney or heart disease needs to tell their physician if they have ever had these disorders before taking bupivacaine liposome.

Significant studies have shown that this medication provides a long-lasting control over pain and could possibly replace the need for opioid use in the future.

Conditions treated:

Local anesthesia injection for surgical or other medical procedures, including:

  • Bariatric
  • Breast
  • Colorectal
  • General
  • Gynecologic
  • Oral/Maxillofacial
  • Orthopedic

Type of medicine:

  • Anesthetic, local

Side effects:

Before deciding to take this medication, ensure that your physician has discussed the risks as well as the benefits for your personal use. Side effects may occur during your treatment as your body adjusts to the medication. It is important to note any allergies that you may have to this medication in addition to other sources of discomfort. In the event of an emergency, consider immediate medical attention if there are signs of an allergic reaction, including anaphylaxis:

  • Breathing difficulties
  • Dizziness
  • Hives
  • Itching
  • Rash
  • Sneezing
  • Swelling of the face, throat, lips, tongue or hands
  • Vomiting

Always consult your physician if there is a continuation of side effects that you find troubling such as these particular issues:

  • Constipation
  • Dizziness
  • Nausea
  • Sweating
  • Vomiting
  • Weight gain

Less common:

  • Anal bleeding
  • Decrease in urine
  • Decreased appetite
  • Headache
  • Hives
  • Irritation
  • Joint pain
  • Tachycardia

More common:

  • Back pain
  • Blurry vision
  • Confusion
  • Drowsiness
  • Muscle spasms
  • Nausea
  • Sweating
  • Unable to sleep

Rare:

  • Agitation
  • Cold sweats
  • Hives
  • Muscle weakness
  • Neck pain
  • Paleness of skin
  • Swelling at surgical site

Your healthcare practitioner will oversee your condition to make sure that there isn’t a reaction to the medication, but if you suffer from the following more serious side effects during and after treatment, tell your physician at once:

  • Abnormal heartbeat
  • Anemia
  • Anxiety
  • Bone cartilage damage
  • Feeling faint
  • Loss of movement
  • Metallic taste in the mouth
  • Numbness where injection was inserted
  • Restlessness
  • Ringing in the ears
  • Shortness of breath
  • Tremors
  • Unusual feeling of hot or cold
  • Vision problems

Contact your health care professional without delay for medical assistance regarding any reactions you may feel or you may report these side effects to the US Food and Drug Administration online or by phone.

Dosage:

One dosage of 266mg based on the size and volume of the surgical site requires coverage of the area of the individual patient. This drug is for single-dose administration only and injected slowly into the soft tissues of the surgical site. Formulations of bupivacaine are not possible to convert from any other formulations of this drug even at the same dose level. Consequently, an injection of a different type of bupivacaine should not take place during the first 96 hours after an injection of Exparel.

Since this medication specifically is for distribution only in either a hospital or clinic setting by a physician, an overdose is unlikely; therefore, it does not have a daily dose regimen.

Major drug Interactions:

140 brand and generic named drugs interact with bupivacaine liposome and although certain medication combinations should not take place together, in some circumstances, a mixture of two medicines grouped together may well be necessary even if an interaction occurs. Your doctor may need to change the dosage or take other precautions as required and all medicines that you currently take should be made aware of to your healthcare professional.

Mixture of this medication should not occur with lidocaine or any other non-bupivacaine-based local anesthetics unless 20 minutes or more has passed following the usage of lidocaine, including any topical medicines containing lidocaine. Caution remains in effect by the physician when adjusting dosage amounts in patients with renal and liver disease.

The following drugs should not remain in use by a patient using bupivacaine liposome unless purposely prescribed by your physician:

  • Fospropofol
  • Hyaluronldase
  • Propoful
  • Propranolol
  • St John’s Wort
  • Verapamil

Additionally, certain medications may cause an increased risk of specific reactions, but, nonetheless, may be the correct treatment for you as prescribed by your physician. As a result, if two medicines prescribed by your health care practitioner happen in combination, your doctor may change the dosage or frequency of these medications in order to help you function properly:

  • Alacepril
  • Benazepril
  • Captopril
  • Cilazapril
  • Delapril
  • Enalaprilat
  • Enalapril Maleate
  • Fosinopril
  • Imidapril
  • Lisinopril
  • Moexipril
  • Pentopril
  • Perindopril
  • Quinapril
  • Ramipril
  • Spirapril
  • Temocapril
  • Trandolapril
  • Zofenopril

Warnings:

There is a possibility of temporary loss of sensation or motor activity with this medication in the area of the injection site. Healthcare professionals should advise pregnant women of the possible risk to an unborn child, although there have not been any direct warnings as to whether or not breastfeeding affects a nursing infant. Bupivacaine remains contraindicated as a replacement for an obstetrical anesthesia block during labor or delivery.

Not enough data exists regarding the effects and safety of bupivacaine liposome injections for patients under the age of 18 but any injection performed in this age range would remain highly monitored. Regarding the elderly, the information collected for this product has not demonstrated any limitations within this particular population. Nevertheless, older patients that have kidney or liver problems might consider the risks and take caution before treatment with this product.

Caution should be in use by the physician during the administration of bupivacaine in the event an accidental injection into a blood vessel occurs which may result in convulsions or cardiac arrest.

If you have stiffness, joint pain or weakness in any other area of your body during or after your surgery, contact your doctor as soon as possible.

Other medical problems:

Bupivacaine liposome is a moderate potential hazard to those patients with cardiovascular disease, liver disease and renal impairment. In these instances, patients may be less able to balance their body changes as a result of using this drug.

In a cardiovascular situation, the medication may be toxic and depress cardiac function, leading to cardiac arrest while patients with liver disease have a greater risk of developing toxic plasma concentrations. Since bupivacaine mainly excretes through the kidneys, it may, however, increase the impairment of renal function; therefore, careful determination in considering the correct dosage amounts for the patient would need to be addressed in addition to the risk factors.

A bone or joint problem, such as Chondrolysis, may increase the risk of more serious side effects and notifying your physician of any condition in this affected area is of the utmost importance.

Storage:

Bupivacaine liposome refrigeration varies between 36 degrees F and 46 degrees F and may be held at 68 degrees F to 77 degrees F for up to 30 days in an unopened, sealed vial. The vials should not be re-refrigerated nor exposed to high temperatures greater than 104 degrees F for extended periods of time.

Never freeze bupivacaine liposome at any time. Do not use if there is product discoloration, or should there be any indication that vial tampering took place especially in terms of a bulging lid.

As with other medications, discard this product as appropriate, due to expiration, if it is no longer needed or unused portions exist. All vials should have a visual inspection before use and re-inverted for suspension of the particles prior to immediate use.

Summary:

Bupivacaine liposome is an anesthetic that numbs and blocks nerve impulses in the area that has had preparations for surgery. Given as a single dose injection in a surgical or hospital setting under the supervision or a physician or health care professional, the release of bupivacaine into the patient extends a therapeutic effect for pain relief and is not used as a typical anesthetic injection for the surgical site.

Physicians should inform their patients well in advance that bupivacaine can cause temporary loss of sensation in the area of the injection site. Awareness of the risks to the cardiovascular, respiratory and central nervous systems must be understood by the patient. All adverse reactions concerning the injection of bupivacaine liposome should include a thorough discussion with the patient as well as what current medications the patient has been prescribed during this time frame.

Bupivacaine liposome can have delayed or long-lasting effects after surgery, thus any treatment by other healthcare professionals after that time period would result in the need of further information from the patient or physician that this injection was part of a treatment plan.

Follow your physician’s instructions regarding any restrictions on food, beverages, or activity in addition to continual, constant contact with your health care practitioner during the use of this treatment as recommended.

Resources
Last Reviewed:
December 23, 2017
Last Updated:
December 22, 2017
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