Alan David Kaye1, Matthew B Novitch2, Sam F Carlson3, Mitchell C Fuller3, Shane W White3, Alexander R Haroldson3, Jennifer A Kaiser3, Mohamed A Elkersh4, Andrew J Brunk4, George M Jeha5, Elyse M Cornett6. 1. Department of Anesthesiology and Pharmacology, Toxicology, and Neurosciences, Louisiana State University School of Medicine, Shreveport, LA, USA. 2. University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA. 3. Medical College of Wisconsin, Milwaukee, WI, 8701 W Watertown Plank Rd, Wauwatosa, WI, 53226, USA. 4. Department of Anesthesiology, LSU Health Sciences Center, Room 656, 1542 Tulane Ave., New Orleans, LA, 70112, USA. 5. LSU School of Medicine, New Orleans, and Research Associate, Department of Anesthesiology, LSU Health Sciences Center, Room 656, 1542 Tulane Ave., New Orleans, LA, 70112, USA. 6. Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA. ecorne@lsuhsc.edu.
Abstract
PURPOSE OF REVIEW: Acute postoperative pain reduction is a major target against the opioid crisis. While opioids have traditionally been the mainstay for postoperative analgesia, current practice has focused on a multimodal approach to pain control, including ultrasound-guided blocks with longer acting local anesthetic agents. RECENT FINDINGS: Non-steroidal anti-inflammatory drugs (NSAIDs), such as meloxicam, are an important class of medications utilized to manage pain in the perioperative period. An additional treatment used in perioperative or postoperative pain relief is Exparel, a bupivacaine (sodium channel blocker) liposomal injectable suspension with a 3-4-day duration of action. The long-acting mechanism and formulation of Exparel consistently has demonstrated decreased opioid use and pain scores in patients undergoing many different surgical procedures. A concern is that pH negatively alters the efficacy of bupivacaine, as in cases of inflamed tissue and acidic fluid pH. For this reason, a combination medication with both meloxicam and bupivacaine has been developed, which normalizes pH and has anti-inflammatory and anti-pain conduction properties. Clinical studies demonstrate that this combination agent can be extremely beneficial in treating postoperative pain. This manuscript summarizes the newest developments with regard to liposomal bupivacaine and the non-steroidal meloxicam, their roles in effective treatment of postoperative pain, contraindications, special considerations of using these medications, and future considerations. HTX-011 pairs up a new extended-release formulation of the local anesthetic bupivacaine with meloxicam, a well-established non-steroidal anti-inflammatory drug (NSAID).
PURPOSE OF REVIEW: Acute postoperative pain reduction is a major target against the opioid crisis. While opioids have traditionally been the mainstay for postoperative analgesia, current practice has focused on a multimodal approach to pain control, including ultrasound-guided blocks with longer acting local anesthetic agents. RECENT FINDINGS: Non-steroidal anti-inflammatory drugs (NSAIDs), such as meloxicam, are an important class of medications utilized to manage pain in the perioperative period. An additional treatment used in perioperative or postoperative pain relief is Exparel, a bupivacaine (sodium channel blocker) liposomal injectable suspension with a 3-4-day duration of action. The long-acting mechanism and formulation of Exparel consistently has demonstrated decreased opioid use and pain scores in patients undergoing many different surgical procedures. A concern is that pH negatively alters the efficacy of bupivacaine, as in cases of inflamed tissue and acidic fluid pH. For this reason, a combination medication with both meloxicam and bupivacaine has been developed, which normalizes pH and has anti-inflammatory and anti-pain conduction properties. Clinical studies demonstrate that this combination agent can be extremely beneficial in treating postoperative pain. This manuscript summarizes the newest developments with regard to liposomal bupivacaine and the non-steroidal meloxicam, their roles in effective treatment of postoperative pain, contraindications, special considerations of using these medications, and future considerations. HTX-011 pairs up a new extended-release formulation of the local anesthetic bupivacaine with meloxicam, a well-established non-steroidal anti-inflammatory drug (NSAID).
Authors: Catherine Vandepitte; Max Kuroda; Richard Witvrouw; Ludwig Anne; Johan Bellemans; Kristoff Corten; Pascal Vanelderen; Dieter Mesotten; Ine Leunen; Micheline Heylen; Sam Van Boxstael; Monika Golebiewski; Marc Van de Velde; Nebojsa Nick Knezevic; Admir Hadzic Journal: Reg Anesth Pain Med Date: 2017 May/Jun Impact factor: 6.288
Authors: Richard A Pollak; Ira J Gottlieb; Fardin Hakakian; John C Zimmerman; Stewart W McCallum; Randall J Mack; Rosemary Keller; Alex Freyer; Wei Du Journal: Clin J Pain Date: 2018-10 Impact factor: 3.442
Authors: Alan D Kaye; Amber N Edinoff; Justin Y Yan; Aaron J Kaye; Michael A Alvarado; Alex D Pham; Azem A Chami; Rutvij J Shah; Bruce M Dixon; Amineh Shafeinia; Elyse M Cornett; Charles Fox Journal: Anesth Pain Med Date: 2022-02-14