Bupivacaine liposome injectable suspension: a new approach to postsurgical pain.

A multivesicular liposomal formulation of bupivacaine which can provide prolonged postsurgical pain relief has been developed. Two pivotal placebo-controlled phase III trials, one in hemorrhoidectomy and one in bunionectomy procedures, showed that wound infiltration of the suspension at the end of surgery could provide analgesia for up to 72 hours, reduce the amount of opiate rescue medications, the time to their first use and increase patient satisfaction. Liposomal bupivacaine was generally well tolerated, with no signal of QTc prolongation or evidence of impaired wound healing. A small open U.S. health economic study showed benefits (versus patient-controlled analgesia) for the preparation in decreasing total opioid use, length of hospital stay and total hospital costs. Further larger studies are warranted, in particular using bupivacaine hydrochloride as the comparator.