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Pharmacokinetic Profile of Liposome Bupivacaine Injection Following a Single Administration at the Surgical Site

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Abstract

Local anaesthetics are often used as part of multimodal pain management techniques to manage postsurgical pain and lessen the need for opioid analgesics; however, the duration of action of traditional formulations of local anaesthetics is short. Liposome bupivacaine is a novel, multivesicular formulation designed for rapid absorption, prolonged release of bupivacaine, and analgesia following a single intra-operative administration into the surgical wound. This article provides a summary of the pharmacokinetic profile of liposome bupivacaine compared with bupivacaine HCl based on data compiled from four randomized, active- and placebo-controlled trials that included pharmacokinetic assessments following single administrations of study drug. Each study evaluated the safety, efficacy and pharmacokinetic profile of liposome bupivacaine in separate surgical populations (patients undergoing inguinal hernia repair, total knee arthroplasty, haemorrhoidectomy or bunionectomy). Pharmacokinetic parameters included maximum plasma drug concentration (Cmax), area under the curve (AUC) for plasma bupivacaine concentration over time extrapolated to infinity (AUC∞), time to observed Cmax (tmax) and terminal elimination half-life of bupivacaine (t½). The studies assessed single administrations of liposome bupivacaine at dose levels ranging from 106 to 532 mg or bupivacaine HCl 100 to 150 mg or placebo (0.9 % sodium chloride) given locally via wound infiltration at the end of surgery prior to wound closure. Male and non-pregnant female patients (n = 253) aged ≥18 years, scheduled to undergo surgery as per the specific protocol for each study, were enrolled. Patient characteristics were stratified by liposome bupivacaine doses ≤266 mg and >266 mg, and bupivacaine HCl treatment arms. Pharmacokinetic parameters for liposome bupivacaine doses of 106, 266, 399 and 532 mg were compared. Plasma concentration versus time profiles were quantitatively similar across these four dose levels of liposome bupivacaine, with an initial peak occurring within 1 h after administration followed by a second peak about 12–36 h later. The overall incidence of adverse events was lower in the liposome bupivacaine ≤266-mg group than the liposome bupivacaine >266-mg and bupivacaine HCl groups (100- or 150-mg doses). In summary, liposome bupivacaine was well tolerated across the four studies and varied surgical models, and exhibited bimodal kinetics with rapid uptake observed during the first few hours and prolonged release through 96 h after administration.

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Acknowledgements

This analysis was funded by Pacira Pharmaceuticals, Inc. DeeDee Hu is a member of an advisory board for Pacira Pharmaceuticals, Inc. Erol Onel is an employee and owns stock in Pacira Pharmaceuticals, Inc. Neil Singla has received a research grant from Pacira Pharmaceuticals, Inc. William G. Kramer has been a paid consultant to Pacira Pharmaceuticals, Inc. Admir Hadzic has received research grants and honoraria as a consultant for Baxter International Inc., Cadence Pharmaceuticals Inc., Macosta Medical USA, LLC, and Pacira Pharmaceuticals, Inc. Editorial assistance was provided by Michael Morren, RPh, MBA, of Peloton Advantage, LLC, supported by Pacira Pharmaceuticals, Inc.

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Authors and Affiliations

  1. Clinical Specialist, Critical Care and Cardiology, Memorial Hermann Memorial City Medical Center, 921 Gessner Road, Houston, TX, 77024, USA

    DeeDee Hu

  2. Pacira Pharmaceuticals, Inc., Parsippany, NJ, USA

    Erol Onel

  3. Lotus Clinical Research, LLC, Pasadena, CA, USA

    Neil Singla

  4. Kramer Consulting LLC, North Potomac, MD, USA

    William G. Kramer

  5. St. Luke’s Hospital, New York, NY, USA

    Admir Hadzic

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  1. DeeDee Hu
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  2. Erol Onel
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  3. Neil Singla
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Correspondence to DeeDee Hu.

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Hu, D., Onel, E., Singla, N. et al. Pharmacokinetic Profile of Liposome Bupivacaine Injection Following a Single Administration at the Surgical Site. Clinical Drug Investigation 33, 109–115 (2013). https://doi.org/10.1007/s40261-012-0043-z

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