Efficacy and safety of liposomal bupivacaine administration in the pediatric population: a scoping review of the literature

Tarika D. Patel, Matthew Dusza, Cheng-Ting Lee
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Abstract

Liposomal bupivacaine (LB; Exparel) is a slow-release formulation of bupivacaine used for postoperative pain control that allows for steady and sustained release of bupivacaine over an extended period of time. Although it has been thoroughly investigated in adults since initial approval in 2011, the efficacy and safety of LB use in pediatric patients have still not been fully explored since its more recent approval for pediatrics in March 2021. To assess the current state of the literature regarding the safety and efficacy of LB use in pediatric patients, we queried three online electronic databases. Overall, 26 articles encompassing 1,496 LB patients were selected for review. Outcome data on adverse events, postoperative opioid use, postoperative pain, length of hospital stay, and total hospital costs were extracted. Two published randomized controlled trials were identified, in addition to 15 retrospective cohort studies and 9 case series/case reports. The most commonly reported measures were postoperative opioid use and pain scores, followed by adverse events, length of hospital stay, and lastly, hospital costs. There were no reported instances of local anesthetic systemic toxicity, and no trends were found between surgery type or administration method (nerve block versus intramuscular injection) and surgical outcomes. While the existing literature suggests that LB may reduce pain scores, hospital costs, length of hospital stay, and opioid use, these findings are significantly limited by potential conflicts of interest, gaps in study design, and inconsistent outcome measures. Overall, there is a scarcity of high-quality studies comparing LB to more commonly used local anesthetics, and further investigation through high-quality studies, such as randomized controlled trials, is warranted to determine if LB should be included as part of a multimodal regimen for postoperative pain management in pediatric patients.

布比卡因脂质体给药在儿科人群中的有效性和安全性:文献综述
布比卡因脂质体;expel)是一种用于术后疼痛控制的布比卡因缓释制剂,可使布比卡因在较长时间内稳定和持续释放。尽管自2011年首次获批以来,已在成人中进行了彻底的研究,但自2021年3月获批用于儿科以来,LB在儿科患者中的疗效和安全性仍未得到充分探讨。为了评估关于儿科患者使用LB的安全性和有效性的文献现状,我们查询了三个在线电子数据库。总的来说,26篇文章包括1496名LB患者被选中进行综述。提取了不良事件、术后阿片类药物使用、术后疼痛、住院时间和总住院费用的结局数据。除15项回顾性队列研究和9项病例系列/病例报告外,还确定了2项已发表的随机对照试验。最常报道的措施是术后阿片类药物使用和疼痛评分,其次是不良事件、住院时间,最后是住院费用。没有局部麻醉全身性毒性的报告,也没有发现手术类型或给药方法(神经阻滞与肌肉注射)与手术结果之间的趋势。虽然现有文献表明LB可能降低疼痛评分、住院费用、住院时间和阿片类药物使用,但这些发现受到潜在利益冲突、研究设计差距和结果测量不一致的显著限制。总的来说,比较LB与更常用的局麻药的高质量研究缺乏,需要通过高质量研究(如随机对照试验)进行进一步调查,以确定LB是否应作为儿科患者术后疼痛管理的多模式方案的一部分。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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