Liposome bupivacaine for pain control after total knee arthroplasty: a meta-analysis

Zhong Qing Wu, Ji Kang Min, Dan Wang, Yong Jian Yuan, Heng Li, Zhong Qing Wu, Ji Kang Min, Dan Wang, Yong Jian Yuan, Heng Li

Abstract

Background: Total knee arthroplasty (TKA) is associated with intense and long-duration pain. Research is currently being conducted on the use of liposome bupivacaine (LB) to prolong the effects of local infiltration anesthesia. This systematic review and meta-analysis of randomized controlled trials (RCTs) evaluated the efficacy and safety of pain control of using LB versus placebo after TKA.

Methods: In April 2016, the Medline, Embase, PubMed, Cochrane Controlled Trials Register (CENTRAL), Web of Science, Google database, and Chinese Wanfang databases were searched to identify articles that compare a LB group versus a control group for pain control after TKA. This systematic review and meta-analysis were performed according to the PRISMA statement criteria. The primary endpoint was the visual analogue scale (VAS) score after TKA at 24, 48, and 72 h. The second outcome was nausea complications, which represent morphine-related side effects. Stata 12.0 software was used for the meta-analysis.

Results: Five studies involving 574 patients met the inclusion criteria. The meta-analysis revealed that LB can decrease the VAS score at 24 h (mean difference (MD) = -0.50; 95 % CI -0.97 to -0.04; P = 0.034), 48 h (MD = -0.26; 95 % CI -0.71 to 0.19; P = 0.256), and 72 h (MD = -0.26; 95 % CI -0.71 to 0.19; P = 0.256). There was no significant difference with respect to the length of hospital stay (MD = -0.08; 95 % CI -0.28 to 0.13; P = 0.475). Furthermore, LB can reduce the occurrence of nausea (RR = 0.38; 95 % CI 0.18 to 0.79; P = 0.009).

Conclusions: Based on the current meta-analysis, LB as a novel anesthetic formulation administration following TKA demonstrated better pain control; however, the sample size was limited, and further RCTs are needed to identify the effects of LB after TKA.

Keywords: Liposome bupivacaine; Meta-analysis; Pain control; Total knee arthroplasty.

Figures

Fig. 1
Fig. 1
The search strategies of the included studies
Fig. 2
Fig. 2
Forest plot of comparison: VAS score at 24 h between the LB group and control group
Fig. 3
Fig. 3
Forest plot comparing VAS score at 48 h between the LB group and control group
Fig. 4
Fig. 4
Forest plot comparing VAS score at 72 h between the LB group and control group
Fig. 5
Fig. 5
Forest plot comparing the length of hospital stay between the LB group and control group
Fig. 6
Fig. 6
Forest plot comparing the occurrence of nausea between the LB group and control group

References

    1. Gramke HF, de Rijke JM, van Kleef M, et al. The prevalence of postoperative pain in a cross-sectional group of patients after day-case surgery in a university hospital. Clin J Pain. 2007;23:543–8. doi: 10.1097/AJP.0b013e318074c970.
    1. Lamplot JD, Wagner ER, Manning DW. Multimodal pain management in total knee arthroplasty: a prospective randomized controlled trial. J Arthroplasty. 2014;29:329–34. doi: 10.1016/j.arth.2013.06.005.
    1. Capdevila X, Barthelet Y, Biboulet P, Ryckwaert Y, Rubenovitch J, d'Athis F. Effects of perioperative analgesic technique on the surgical outcome and duration of rehabilitation after major knee surgery. Anesthesiology. 1999;91:8–15. doi: 10.1097/00000542-199907000-00006.
    1. Sun XL, Zhao ZH, Ma JX, et al. Continuous local infiltration analgesia for pain control after total knee arthroplasty: a meta-analysis of randomized controlled trials. Medicine (Baltimore) 2015;94:e2005. doi: 10.1097/MD.0000000000002005.
    1. Wang C, Cai XZ, Yan SG. Comparison of periarticular multimodal drug injection and femoral nerve block for postoperative pain management in total knee arthroplasty: a systematic review and meta-analysis. J Arthroplasty. 2015;30:1281–6. doi: 10.1016/j.arth.2015.02.005.
    1. Dong CC, Dong SL, He FC. Comparison of adductor canal block and femoral nerve block for postoperative pain in total knee arthroplasty: a systematic review and meta-analysis. Medicine (Baltimore) 2016;95:e2983. doi: 10.1097/MD.0000000000002983.
    1. Fan L, Yu X, Zan P, Liu J, Ji T, Li G. Comparison of local infiltration analgesia with femoral nerve block for total knee arthroplasty: a prospective, randomized clinical trial. J Arthroplasty. 2015;31:1361–5. doi: 10.1016/j.arth.2015.12.028.
    1. Kurosaka K, Tsukada S, Seino D, Morooka T, Nakayama H, Yoshiya S. Local infiltration analgesia versus continuous femoral nerve block in pain relief after total knee arthroplasty: a randomized controlled trial. J Arthroplasty. 2015;31:913–37. doi: 10.1016/j.arth.2015.10.030.
    1. White S, Vaughan C, Raiff D, Eward W, Bolognesi M. Impact of liposomal bupivacaine administration on postoperative pain in patients undergoing total knee replacement. Pharmacotherapy. 2015;35:477–81. doi: 10.1002/phar.1587.
    1. Bagsby DT, Ireland PH, Meneghini RM. Liposomal bupivacaine versus traditional periarticular injection for pain control after total knee arthroplasty. J Arthroplasty. 2014;29:1687–90. doi: 10.1016/j.arth.2014.03.034.
    1. Bramlett K, Onel E, Viscusi ER, Jones K. A randomized, double-blind, dose-ranging study comparing wound infiltration of DepoFoam bupivacaine, an extended-release liposomal bupivacaine, to bupivacaine HCl for postsurgical analgesia in total knee arthroplasty. Knee. 2012;19:530–6. doi: 10.1016/j.knee.2011.12.004.
    1. Schroer WC, Diesfeld PG, LeMarr AR, Morton DJ, Reedy ME. Does extended-release liposomal bupivacaine better control pain than bupivacaine after total knee arthroplasty (TKA)? A prospective, randomized clinical trial. J Arthroplasty. 2015;30:64–7. doi: 10.1016/j.arth.2015.01.059.
    1. Schwarzkopf R, Drexler M, Ma MW, et al. Is there a benefit for liposomal bupivacaine compared to a traditional periarticular injection in total knee arthroplasty patients with a history of chronic opioid use? J Arthroplasty. 2016 [Epub ahead of print].
    1. Surdam JW, Licini DJ, Baynes NT, Arce BR. The use of exparel (liposomal bupivacaine) to manage postoperative pain in unilateral total knee arthroplasty patients. J Arthroplasty. 2015;30:325–9. doi: 10.1016/j.arth.2014.09.004.
    1. Collis PN, Hunter AM, Vaughn MD, Carreon LY, Huang J, Malkani AL. Periarticular injection after total knee arthroplasty using liposomal bupivacaine vs a modified Ranawat suspension: a prospective, randomized study. J Arthroplasty. 2016;31:633–6. doi: 10.1016/j.arth.2015.09.025.
    1. Cien AJ, Penny PC, Horn BJ, Popovich JM, Taunt CJ. Comparison between liposomal bupivacaine and femoral nerve block in patients undergoing primary total knee arthroplasty. J Surg Orthop Adv. 2015;24:225–9. doi: 10.3113/JSOA.2015.0225.
    1. Ranade VV. Drug delivery systems. 1. Site-specific drug delivery using liposomes as carriers. J Clin Pharmacol. 1989;29:685–94. doi: 10.1002/j.1552-4604.1989.tb03403.x.
    1. Hadzic A, Minkowitz HS, Melson TI, et al. Liposome bupivacaine femoral nerve block for postsurgical analgesia after total knee arthroplasty. Anesthesiology. 2016;124:1372–83. doi: 10.1097/ALN.0000000000001117.
    1. Chughtai M, Cherian JJ, Mistry JB, Elmallah RD, Bennett A, Mont MA. Liposomal bupivacaine suspension can reduce lengths of stay and improve discharge status of patients undergoing total knee arthroplasty. J Knee Surg. 2016;29:224–7. doi: 10.1055/s-0036-1571431.

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner