Liposomal Bupivacaine
Liposomal Bupivacaine (LB)
These notes are no substitute for sound medical knowledge and training.
Clinicians should always use and rely upon their clinical judgment and decision making.
All information presented must first be confirmed for accuracy prior to use in patient care.
FDA Product Insert
1.33% = 13.3 mg/ml
"Recommended" dose is 20 ml (or less depending upon patient and clinical factors).
"Recommended" dose is 10 ml for interscalene blocks.
Can expand volume (dilute) with NS or LR: do not dilute with hypotonic solutions.
Maximum dilution is 1:14 (0.89 mg/ml)
Add up to 280 ml for total volume of 300 ml
Inject with 25 gauge needle or larger to avoid disrupting liposomal particles.
"Substantially excreted by the kidney"
"Metabolized by the liver"
Admixing
Do not mix with other local anesthetics except bupivacaine.
(Can give after "lidocaine after a delay of 20 minutes or more")
"Avoid additional local anesthesia within 96 hours after liposomal bupivacaine"
"Do not exceed a milligram dose of bupivacaine to liposomal bupivacaine of 1:2."
Examples:
20 ml liposomal bupivacaine = 266 mg bupivacaine
1:2 is 133 mg bupivicaine = 53 ml 0.25% bupivicaine
or 26 ml 0.5% bupivicaine
10 ml liposomal bupivacaine = 133 mg bupivacaine
1:2 is 66 mg bupivicaine = 26 ml 0.25% bupivicaine
or 13 ml 0.5% bupivicaine
FDA Case Studies
FDA insert lists only bunionectomy, hemorrhoidectomy, and interscalene blocks.
Bunionectomy: 8ml liposomal bupivacaine (LB)
Hemorrhoidectomy: 20 ml liposomal bupivacaine + 10 ml NS
Interscalene or Supraclavicular: 10 ml LB with 10 ml NS to expand to 20 ml
Studies do not support usage for femoral nerve block in total knee arthroplasty.
"Off Label" Case Studies
Interscalene block
10 ml liposomal bupivacaine admixed with 10 ml 0.5% bupivacaine
Bilateral Transversus Abdominis Plane (TAP) Block
20 ml liposomal bupivacaine admixed with 20 ml 0.25% Bupivacaine and 20 ml NS
Inject 30 ml to each side
