Key result
Liposomal bupivacaine injection linked to ~45% lower risk of major post-hip fracture complications.
Why the study?
Whether surgical site injection of liposomal bupivacaine can reduce the incidence of major complications after hip fracture in elderly patients remains unclear.
Does surgical site injection of liposomal bupivacaine reduce the 90-day incidence of major complications in elderly patients undergoing surgical treatment for hip fracture?
Cohort
Does surgical site injection of liposomal bupivacaine reduce the 90-day incidence of major complications in elderly patients undergoing surgical treatment for hip fracture?
Surgical site injection of liposomal bupivacaine may reduce the 90-day incidence of major complications in elderly patients undergoing hip fracture surgery.
Answers are grounded in this paper and cite their sources.
LB injection may lower complications in elderly hip fracture surgery; leaves open confirmation via RCTs before practice change.
BACKGROUND: Early recovery of mobilization after geriatric hip fracture is associated with lower complication incidence and mortality. Whether surgical site injection of liposomal bupivacaine (LB) can reduce incidence of major complications after hip fracture in elderly population remains unclear. MATERIALS AND METHODS: In this nonrandomized trial, we enrolled participants of an observational cohort who received surgical treatment of a hip fracture and were aged 65 years or older from October 2023 to June 2024. We used the participants of this observational cohort from October 2020 to September 2023 as historical control. The primary outcome was a pre-defined composite of major complications including mortality, stroke, myocardial infarction, sepsis, major bleeding, venous thromboembolism, pressure ulcer, and pneumonia within 90 postoperative days. Secondary outcomes were all-cause mortality, weight-bearing within 24 hours after surgery, and delirium within 7 postoperative days. RESULTS: In this study, 134 patients received surgical site injection of LB to attenuate postoperative pain intensity and completed the 90-day follow-up. Patients in the LB group had a reduced incidence of major complications within 90 days [19 (14.2%) patients vs. 167 (24.6%) patients] compared with patients in the control group, with an adjusted hazard ratio (HR) of 0.55 [95% confidence interval (CI) 0.34-0.89, P = .014]. For secondary endpoints, death occurred in 8 (6.0%) patients of the LB group and 58 (8.5%) of the control group, with an HR of 0.74 (0.35-1.56, P = 0.432). The incidence of delirium was similar between the two group [LB group 6 patients (4.5%) vs. control group 49 (7.2%) patients, P = 0.254]. Seventy-three patients in the LB group (54.5%) achieved weight-bearing within 24, while 225 patients in the control group (33.1%) achieved this goal, with an odds ratio of 2.40 (1.64-3.51, P < 0.001). CONCLUSIONS: With surgical site injection of LB, patient might have reduced incidence of major complications. The benefits of LB regarding all-cause mortality and delirium were not observed in this study, possibly due to insufficient power. Future randomized clinical trials with larger sample sizes were warranted by the current study.
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Zhu et al. (2025) conducted a cohort in Hip fracture. Surgical site injection of liposomal bupivacaine vs. Historical control was evaluated on Composite of major complications including mortality, stroke, myocardial infarction, sepsis, major bleeding, venous thromboembolism, pressure ulcer, and pneumonia within 90 postoperative days (HR 0.55, 95% CI 0.34-0.89, p=0.014). Surgical site injection of liposomal bupivacaine reduced the 90-day incidence of major complications after hip fracture compared to historical controls.
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