ESRA Academy. Leunen I. Sep 9, 2016; 138396; 0238 Topic: Local Anaesthetics
Dr. Ine Leunen
Dr. Ine Leunen

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Background and Aims:

Collagenase clostridium histolyticum (Xiapex®) is used to treat Dupuytren’s contractures. In the first phase, Xiapex® is injected into the Dupuytren’s cord; in the second phase 48 hours later, the fingers are manipulated to disrupt the cords. Both phases are painful, with the second phase often necessitating general or local anesthesia.  We examined the efficacy and duration of sensory blockade with liposome bupivacaine (Exparel®) when used as a single injection in wrist blocks. 


After IRB approval, 16 consecutive patients received US-guided distal median and ulnar nerve blocks with an 8 mL mixture of 0.5% bupivacaine HCl and liposome bupivacaine (Exparel®) in varying ratios of 50:50 to 30:70. An additional four consecutive patients received bupivacaine HCl only.  Sensory block of the hand was assessed for 5 days after the blocks were administered.


Liposome bupivacaine (Exparel®) provided complete anesthesia and analgesia for both phases of the procedure in 60% of the patients. Sensory blocks with liposome bupivacaine lasted up to 72 hours, whereas blocks with bupivacaine HCl only wore off within 15 hours. Of note, sensory blocks in patients receiving liposome bupivacaine typically returned a few hours after the blocks with bupivacaine HCl wore off (Figure 1).


Median and ulnar blocks with liposome bupivacaine (Exparel®) provided complete anesthesia for both phases in the treatment for Dupuytren’s contracture. Dose-finding studies are indicated to determine the optimal dose of liposome bupivacaine for consistent nerve blockade of the wrist over the desired therapeutic range.

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