Key result
Liposomal bupivacaine reduced 72-hour postoperative opioid use in knee arthroplasty patients compared to control (209.4 vs 247.8 mg) and decreased length of stay, but was associated with higher pain scores.
Why the study?
Does intraoperative liposomal bupivacaine reduce concurrent opioid use and improve pain scores in patients undergoing orthopedic knee and hip arthroplasty?
Cohort (n=357)
No
Does intraoperative liposomal bupivacaine reduce concurrent opioid use and improve pain scores in patients undergoing orthopedic knee and hip arthroplasty?
Liposomal bupivacaine produced a modest decrease in opioid use and length of stay but was associated with slightly higher pain scores, suggesting limited utility for orthopedic joint arthroplasty.
Answers are grounded in this paper and cite their sources.
Observational data link lower opioid use but higher pain scores to liposomal bupivacaine after knee arthroplasty; leaves open net benefit pending RCTs.
Objective: The objective of this study was to assess the association between liposomal bupivacaine use in patients undergoing knee or hip arthroplasty and concurrent pain control, length of hospitalization, and physical therapy milestones. Methods: This was a retrospective chart review. Patients receiving liposomal bupivacaine during a 1-year period (study group) were compared with patients seen by the same surgeon in the previous year who did not receive liposomal bupivacaine (control group). Clinical outcomes included concurrent opioid use, average pain scores, length of stay, ambulation, and range of motion. Results: A total of 357 patients were included in the study. Knee study group patients received lower amounts of opioid (209 vs 248 mg; P = .02) and had a delayed time to first rescue medication (6.3 ± 4.7 vs 5.0 ± 4.4 hours; P = .02). Hip study group patients had a delay in time to first rescue medication (7.1 ± 6.3 vs 4.9 ± 4.0 hours; P = .046). Both knee and hip study group patients had higher average pain score during the 72-hour postoperative period (6.38 vs 6.06; P = .01, and 6.32 vs 5.80; P = .02, respectively) but decreased median length of stay (2.0 vs 3.0 days; P < .0001, and 2.0 vs 3.0 days; P = .04, respectively). Conclusions: Use of liposomal bupivacaine produced a modest decrease in opioid use among knee patients and a decreased length of stay in both knee and hip patients; however, this was accompanied by a non-clinically significant increase in pain scores for knee and hip patients suggesting limited utility for orthopedic procedures.
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Jacob et al. (2017) conducted a cohort in Orthopedic knee or hip arthroplasty (n=357). Liposomal bupivacaine vs. Intraoperative dose of bupivacaine hydrochloride 0.5% with epinephrine, morphine, and ketorolac was evaluated on Concurrent opioid analgesic medication use during the 72-hour postoperative period (mg morphine equivalents) in knee arthroplasty patients (p=0.02). Liposomal bupivacaine reduced 72-hour postoperative opioid use in knee arthroplasty patients compared to control (209.4 vs 247.8 mg) and decreased length of stay, but was associated with higher pain scores.
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