布比卡因脂质体效果如何？

本文由“小麻哥的日常”授权转载

今天看到一篇文章，是关于布比卡因脂质体的。

这个药没有用过，特意百度了一下这个药，发现其作用机制和普通布比卡因等局麻药类似，在美国已获准用于临床。

这个药就是文章中涉及的药，商品名是Exparel。

说明书上适应症主要是局部浸润麻醉和肌间沟神经阻滞麻醉，局部浸润最大用量是266mg(20ml)，神经阻滞是133mg(10ml)。用于术后镇痛，使用期间要加强监测。肝病患者慎用。但这个药我们临床上没有用过，如您有使用经验，欢迎留言分享！

摘要译文

布比卡因脂质体浸润和外周神经阻滞治疗术后疼痛的临床效果

作者汇总了已发表的76项应用布比卡因脂质体（Exparel; Pacira Pharmaceuticals, USA）控制术后疼痛的随机对照研究。

当术区浸润时，与无包被的布比卡因或罗哌卡因比较，只有11%的研究报道了应用布比卡因脂质体在首要结局上有临床优势及统计学意义 (4 of 36) 。

92%的研究发现使用未包被的布比卡因外周神经阻滞的镇痛效果优于布比卡因脂质体浸润麻醉(11 of 12)。

在16项研究中布比卡因脂质体和未包被布比卡因用于外周神经阻滞的效果好坏参半。

总的来讲，高偏倚试验中84%(16 of 19)的报告了首要结局有显著统计学差异，而低偏倚试验中，仅有14%(4 of 28) 的有统计学差异。

已有证据不能证明布比卡因脂质体优于标准的局麻药。

原文摘要

Clinical Effectiveness of Liposomal Bupivacaine Administered by Infiltration or Peripheral Nerve Block to Treat Postoperative Pain

The authors provide a comprehensive summary of all randomized, controlled trials (n = 76) involving the clinical administration of liposomal bupivacaine (Exparel; Pacira Pharmaceuticals, USA) to control postoperative pain that are currently published. When infiltrated surgically and compared with unencapsulated bupivacaine or ropivacaine, only 11% of trials (4 of 36) reported a clinically relevant and statistically significant improvement in the primary outcome favoring liposomal bupivacaine. Ninety-two percent of trials (11 of 12) suggested a peripheral nerve block with unencapsulated bupivacaine provides superior analgesia to infiltrated liposomal bupivacaine. Results were mixed for the 16 trials comparing liposomal and unencapsulated bupivacaine, both within peripheral nerve blocks. Overall, of the trials deemed at high risk for bias, 84% (16 of 19) reported statistically significant differences for their primary outcome measure(s) compared with only 14% (4 of 28) of those with a low risk of bias. The preponderance of evidence fails to support the routine use of liposomal bupivacaine over standard local anesthetics.