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Liposomal bupivacaine is an extended-release formulation of the amide-type local anesthetic bupivacaine, encapsulated within multivesicular liposomes using DepoFoam technology. This delivery system allows for a slow, sustained release of bupivacaine, providing prolonged postsurgical analgesia for up to 72 hours, which is significantly longer than the duration of standard bupivacaine. It works by binding to the intracellular portion of voltage-gated sodium channels, blocking sodium influx and preventing the generation and conduction of nerve impulses. Developed by Pacira BioSciences and marketed as Exparel, it is FDA-approved for local infiltration, field blocks, and interscalene brachial plexus nerve blocks to manage postoperative pain. Clinical studies, such as those conducted by Indiana University, have also explored its use in combination with adjuvants like dexamethasone to further prolong its analgesic effect in procedures like rotator cuff surgery.
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