Core-shell polymer microspheres with poly(d,l-lactic-co-glycolic acid) (PLGA) core and poly(l-lactic acid) (PLLA) shell were developed for sustained release of bupivacaine for postoperative pain relief after knee surgery. The PLLA-rich shell acted as a diffusion barrier, allowing linear release of bupivacaine in a goat model over an extended period of 2 weeks post-surgery. In vivo bupivacaine concentrations in the goat synovial fluid remained within therapeutic levels for the 2 weeks, whereas bupivacaine concentrations in the blood plasma remained safely below toxic levels. All animals survived until the end of the 28 day study, with no inflammation, infection or reduced mobility. Explantation at day 28 revealed some soft microsphere remnants in the para-patellar space of the knee joint. However, there was no damage to the articular surfaces, or interference with joint motion. Histological analysis of each knee compartment did not reveal any signs of osteoarthrosis or degeneration within the joints, and safranin-O staining showed intact cartilage surfaces with well-preserved proteoglycan content.
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http://dx.doi.org/10.1039/c4tb00948g | DOI Listing |
J Hand Surg Glob Online
November 2024
Department of Orthopaedic Surgery, University of Massachusetts Chan Medical School, Worcester, MA.
In this case report, we present a novel occurrence of acute hepatitis 2 weeks after local bupivacaine injection for wide awake, local anesthesia, no tourniquet carpal tunnel release. Laboratory and biopsy analysis confirmed cholestatic, drug-induced hepatitis that was successfully managed with conservative treatment. With a paucity of potential bupivacaine-induced hepatitis cases reported within the literature, the importance of broad differential diagnosis, meticulous medication reconciliation, and consideration of this rare complication should not be understated by the astute hand surgeon.
View Article and Find Full Text PDFAdv Healthc Mater
December 2024
Department of Chemistry, Duke University, Durham, NC, 27708, USA.
Safe, effective pain management remains one of the biggest challenges following surgical procedures. Despite widespread recognition of this problem and advances in the mechanistic understanding of pain signaling, post-surgical pain is often undermanaged, with opioid use remaining the clinical standard. As an alternative to current oral, systemic treatments, a degradable bupivacaine-loaded poly(ester urea) (PEU) thin film has been developed to deliver bupivacaine directly to the site of injury over an extended duration.
View Article and Find Full Text PDFCan J Anaesth
December 2024
Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.
Purpose: Same-day mobilization and early hospital discharge is increasingly emphasized following hip and knee arthroplasty. One challenge of spinal anesthesia in this setting is achieving adequate block height while avoiding excessively large local anesthetic doses and prolonged motor and sensory blockade. Using a hypobaric local anesthetic solution is one potential strategy, as its intrathecal distribution can be reliably manipulated by patient positioning to achieve adequate block height independent of dose.
View Article and Find Full Text PDFCureus
November 2024
Anaesthesiology, Dr. D Y Patil Medical College, Hospital and Research Centre, Dr. D Y Patil Vidyapeeth, Pune, IND.
Introduction Laparoscopic cholecystectomy, despite its several advantages, is sometimes associated with discomfort due to pain in the immediate postoperative period. Effective management of this pain is critical for enhancing recovery, minimizing complications, and facilitating early discharge. The use of local anesthetics for intra-abdominal analgesia, specifically bupivacaine and ropivacaine, has been investigated as a means to improve postoperative pain control.
View Article and Find Full Text PDFSurg Obes Relat Dis
October 2024
Department of Surgery, Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana.
Background: Patients undergoing bariatric surgery may be at increased risk for postsurgical opioid dependence, highlighting a need for opioid-sparing anesthesia.
Objectives: Liposomal bupivacaine (LB), a prolonged release formulation of bupivacaine, may improve postoperative pain management and reduce postsurgical opioid use. This retrospective claims-database study investigated the effects of LB versus non-LB analgesia on opioid use and healthcare resource utilization (HCRU) in patients receiving laparoscopic sleeve gastrectomy (SG).
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