Preventing Local Anesthetic Systemic Toxicity Associated with Liposomal Bupivacaine Use

UNCG Author/Contributor (non-UNCG co-authors, if there are any, appear on document)

Elsa Althof (Creator)

Institution

The University of North Carolina at Greensboro (UNCG )

Web Site: http://library.uncg.edu/

Advisor

Terry Wicks

Abstract: Background: Local anesthetic administration has become an integral part of pain management in the perioperative setting. However, all local anesthetics have the potential for causing local anesthetic systemic toxicity (LAST), a condition that may result in patient morbidity and mortality. Novel formulations of local anesthetics, such as long-acting liposomal bupivacaine (Exparel?), have the potential to cause or contribute to LAST development over 96 hours past administration. Anesthesia providers must be vigilant about the risks of administration of additional local anesthetics when a patient has received Exparel?. Purpose: To reduce the incidence of accidental LAST in patients treated with Exparel? at a southeastern urban hospital. Methods: Anesthesia providers at the study hospital received an educational presentation reviewing Exparel?’s pharmacology, LAST signs/symptoms, and LAST treatment. Results: Twenty-five (n = 25) anesthesia providers participated in a pre- and post-educational presentation test, with a statistically significant rise in test scores. Despite a measurable increase in provider knowledge regarding the risks and consequences of administration of additional local anesthetics following Exparel? administration, this did not result in a decrease in the administration of local anesthetics with Exparel?. Conclusion and Recommendations: Anesthesia providers should remain ever vigilant of LAST risks and an educational session about Exparel? and LAST can help providers review best practices in prevention and treatment. The implementation of an intraoperative alert in the electronic medical record to notify anesthesia providers of the prior administration of Exparel? could further reduce the incidence of local anesthetic administration during the period of increased risk of LAST. Further studies investigating Exparel? and other local anesthetic use should be conducted to advance our knowledge on their use and toxicities.

Preventing Local Anesthetic Systemic Toxicity Associated with Liposomal Bupivacaine Use
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Created on 6/25/2024
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Additional Information

Publication

Other

Language: English

Date: 2024

Keywords

liposomal bupivacaine, Exparel, local anesthetic systemic toxicity, LAST

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