Evaluating the effect of liposomal bupivacaine in supraclavicular brachial plexus block

A recent study published in Anesthesiology investigated the effectiveness of adding liposomal bupivacaine to standard bupivacaine in supraclavicular brachial plexus blocks for patients undergoing distal radial fracture surgeries. Supraclavicular brachial plexus blocks are widely used for regional anesthesia in upper limb surgeries, including wrist and hand procedures. While standard bupivacaine provides effective pain relief, its duration is limited, and patients often experience rebound pain within 24 hours of surgery. This rebound pain can result in increased opioid consumption and delayed recovery. Liposomal bupivacaine (Exparel ®), which is designed for extended release, offers the potential to prolong pain relief, but its use in this context has not been extensively studied. The aim of the research was to evaluate whether combining liposomal bupivacaine with standard bupivacaine could improve pain management during the critical first 48 hours after surgery, thereby reducing opioid use and improving recovery outcomes.

Study objective and methods

This randomized, double-blind trial was designed to compare the efficacy of liposomal bupivacaine versus standard bupivacaine alone in supraclavicular brachial plexus blocks. The trial included 80 patients undergoing distal radial fracture surgery, who were randomly assigned to one of two groups:

• Liposomal bupivacaine group: Patients in this group received a combination of 10 mL of 0.5% plain bupivacaine and 10 mL of 1.33% liposomal bupivacaine, providing a total volume of 20 mL.
• Standard bupivacaine group: Patients in this group were administered 20 mL of 0.5% plain bupivacaine.

The primary outcome measured was postoperative pain, assessed using a numerical rating scale (NRS) over a 48-hour period. Secondary outcomes included pain during movement, overall analgesic use, and functional recovery. The study also monitored for any adverse effects, including sensory and motor function changes, to ensure the safety and comparability of both treatments.

Key findings

• Pain reduction: The liposomal bupivacaine group had significantly lower pain scores at rest (0.6 vs. 1.4, p < 0.001) in the first 48 hours, showing improved early pain relief.
• Pain during movement: Pain during movement was also lower on postoperative day 1 (2.7 vs. 4.9, p < 0.001), aiding in early mobilization. 
• Analgesic benefit: The liposomal bupivacaine group had a higher overall benefit with analgesia score (1.1 vs. 1.7, p = 0.020), reflecting better pain control and patient satisfaction.
• Limited long-term benefit: Beyond 48 hours, there were no significant differences in pain scores, recovery, or functional outcomes between the two groups.
• Adverse effects: Both groups had similar rates of side effects, with no differences in sensory or motor function, indicating comparable safety.

Conclusion

The study concluded that adding liposomal bupivacaine to standard bupivacaine in supraclavicular brachial plexus blocks provided significantly better pain relief during the first 48 hours post-surgery, particularly reducing pain at rest and during movement. However, beyond this period, there were no notable long-term advantages in terms of pain control, recovery, or functional outcomes compared to standard bupivacaine alone.

Future research

While the immediate postoperative benefits are promising, further research is needed to evaluate the long-term effectiveness of liposomal bupivacaine, its potential in other surgical procedures, and whether it can consistently reduce opioid consumption and enhance overall patient recovery in various clinical settings.

 For more detailed information, refer to the full article in Anesthesiology

 Chan TCW, Wong JSH, Wang F, et al. Addition of Liposomal Bupivacaine to Standard Bupivacaine versus Standard Bupivacaine Alone in the Supraclavicular Brachial Plexus Block: A Randomized Controlled Trial. Anesthesiology. 2024;141(4):732-744.

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