{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T09:01:24Z","timestamp":1791536484701,"version":"4.3.4"},"reference-count":29,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2020,11,4]],"date-time":"2020-11-04T00:00:00Z","timestamp":1604448000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["KL2 TR002379"],"award-info":[{"award-number":["KL2 TR002379"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pain Practice"],"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Objectives<\/jats:title><jats:p>Optimizing perioperative analgesia for patients undergoing major lower\u2010extremity amputation remains a considerable challenge. The utility of liposomal bupivacaine as a component of peripheral nerve blockade for lower\u2010extremity amputation is unknown.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted an observational study comparing three different perioperative analgesic techniques for adults undergoing major lower\u2010extremity amputation under general anesthesia between 2012 and 2017 at an academic medical center: (1) no regional anesthesia, (2) peripheral nerve blockade with standard bupivacaine, and (3) peripheral nerve blockade with a mixture of standard and liposomal bupivacaine. The primary outcome of cumulative opioid oral morphine milligram equivalent utilization in the first 72\u00a0hours postoperatively was compared across groups utilizing multivariable linear regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 631 unique anesthetics were included for 578 unique patients, including 416 (66%) without regional anesthesia, 131 (21%) with peripheral nerve blockade with a mixture of standard and liposomal bupivacaine, and 84 (13%) with peripheral nerve blockade with standard bupivacaine alone. Cumulative morphine equivalents were lower in those receiving peripheral nerve blockade with combined standard and liposomal bupivacaine compared with those not receiving regional anesthesia (multiplicative increase 0.67; 95% CI 0.50 to 0.90; <jats:italic>P<\/jats:italic>\u00a0=\u00a00.007). There were no significant differences in opioid utilization between peripheral nerve blockade groups (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.59).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Peripheral nerve blockade is associated with reduced opioid requirements after lower\u2010extremity amputation compared with general anesthesia alone. However, the incorporation of liposomal bupivacaine is not significantly different to blockade employing only standard bupivacaine.<\/jats:p><\/jats:sec>","DOI":"10.1111\/papr.12959","type":"journal-article","created":{"date-parts":[[2020,10,15]],"date-time":"2020-10-15T15:33:37Z","timestamp":1602776017000},"page":"299-307","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Peripheral Nerve Blockade with Combined Standard and Liposomal Bupivacaine in Major Lower\u2010Extremity Amputation"],"prefix":"10.1111","volume":"21","author":[{"given":"Catalina I.","family":"Dumitrascu","sequence":"first","affiliation":[{"name":"Department of Anesthesiology &amp; Perioperative Medicine Mayo Clinic  Rochester Minnesota U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6435-368X","authenticated-orcid":false,"given":"Nafisseh S.","family":"Warner","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology &amp; Perioperative Medicine Mayo Clinic  Rochester Minnesota U.S.A."},{"name":"Division of Pain Medicine Mayo Clinic  Rochester Minnesota U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas M.","family":"Stewart","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology &amp; Perioperative Medicine Mayo Clinic  Rochester Minnesota U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam W.","family":"Amundson","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology &amp; Perioperative Medicine Mayo Clinic  Rochester Minnesota U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danette L.","family":"Bruns","sequence":"additional","affiliation":[{"name":"Anesthesia Clinical Research Unit Mayo Clinic  Rochester Minnesota U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew C.","family":"Hanson","sequence":"additional","affiliation":[{"name":"Division of Biomedical Statistics Mayo Clinic  Rochester Minnesota U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phillip J.","family":"Schulte","sequence":"additional","affiliation":[{"name":"Division of Biomedical Statistics Mayo Clinic  Rochester Minnesota U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark M.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology &amp; Perioperative Medicine Mayo Clinic  Rochester Minnesota U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Brown","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology &amp; Perioperative Medicine Mayo Clinic  Rochester Minnesota U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam D.","family":"Niesen","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology &amp; Perioperative Medicine Mayo Clinic  Rochester Minnesota U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos B.","family":"Mantilla","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology &amp; Perioperative Medicine Mayo Clinic  Rochester Minnesota U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6625-8755","authenticated-orcid":false,"given":"Matthew A.","family":"Warner","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology &amp; Perioperative Medicine Mayo Clinic  Rochester Minnesota U.S.A."},{"name":"Division of Critical Care Medicine Mayo Clinic  Rochester Minnesota U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,11,4]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2015.04.030"},{"key":"e_1_2_8_3_1","first-page":"17","article-title":"Preventive analgesia for postoperative pain control: a broader concept","volume":"7","author":"Vadivelu N","year":"2014","journal-title":"Local Reg Anesth"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/2049463717736492"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/bjaed\/mkv028"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(02)00074-1"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0b013e3181f4e848"},{"key":"e_1_2_8_8_1","first-page":"179","article-title":"Continuous regional analgesia by intraneural block: effect on postoperative opioid requirements and phantom limb pain following amputation","volume":"31","author":"Elizaga AM","year":"1994","journal-title":"J Rehabil Res Dev"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0b013e31820fc7d2"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(97)06315-0"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2007.05.011"},{"key":"e_1_2_8_12_1","first-page":"324","article-title":"Prevention of phantom pain after major lower limb amputation by epidural infusion of diamorphine, clonidine and bupivacaine","volume":"76","author":"Jahangiri M","year":"1994","journal-title":"Ann R Coll Surg Engl"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/00115550-200107000-00007"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.avsg.2010.03.026"},{"key":"e_1_2_8_15_1","unstructured":"RabinT.FDA in brief: FDA approves new use of exparel for nerve block pain relief following shoulder surgeries.https:\/\/www.fda.gov\/news-events\/fda-brief\/fda-brief-fda-approves-new-use-exparel-nerve-block-pain-relief-following-shoulder-surgeries. 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