Liposome bupivacaine in peripheral nerve blocks and epidural injections to manage postoperative pain

Introduction: The duration of postsurgical pain greatly outlasts the duration of analgesia (typically < 12 h) following single administration of traditional formulations of local anesthetics. Bupivacaine, one of the most widely studied and extensively used local anesthetics, is now available in a liposomal formulation that has shown promise of providing postsurgical analgesia for a duration of up to 72 h when administered as part of a peripheral (e.g., femoral) or neuraxial (e.g., epidural) nerve block. However, it is currently approved for administration in the surgical site. Areas covered: This publication provides an overview of liposome bupivacaine and its potential utility in peripheral nerve blocks and epidural administration. Expert opinion: The potential to provide postoperative analgesia lasting 3 days with a single administration at the time of surgery holds considerable promise. This modality could have distinct advantages over currently available techniques, such as continuous perineural local anesthetic infusion, as it would preclude the need for a catheter and pump. However, potential risks and benefits of liposome bupivacaine in peripheral and neuraxial nerve blocks must be further elucidated in surgical populations, and US Food and Drug Administration (FDA) approval must be granted for these indications. Until FDA approval is provided, the use of liposome bupivacaine in peripheral and neuraxial nerve blocks must be considered investigational.