Periarticular injection of liposomal bupivacaine in total knee arthroplasty

Bradley T Webb, J Reid Spears, Langan S Smith, Arthur L Malkani, Bradley T Webb, J Reid Spears, Langan S Smith, Arthur L Malkani

Abstract

The purpose of this study was to determine whether the use of a periarticular injection using liposomal bupivacaine could decrease pain and improve outcomes after total knee arthroplasty. Fifty consecutive patients received no periarticular injections (group A). Another 50 consecutive patients received a periarticular injection of liposomal bupivacaine (group B). There were no differences in the groups with respect to gender, age, body mass index (BMI), or comorbidities. There was a significant reduction in the amount of narcotics used in the liposomal bupivacaine group (60.97-mg oral morphine equivalent vs 89.74 mg, P = 0.009). Patients in group B with a BMI <40 and a Charlson comorbidity index of 0-3 had decreased length of stay (2.64 vs 3.06 days, P = .004), narcotic use over 24-48 hours (110.66 vs 182.47 mg, P = .013), and narcotic use over 48-72 hours (49.61 vs. 112.65 mg, P = .004). In patients with a BMI <40 and comorbidity index of ≤3, periarticular injection using liposomal bupivacaine leads to earlier discharge along with decreased use of narcotics.

Keywords: Liposomal bupivacaine; Pain; Postoperative; Total knee arthroplasty.

References

    1. Cram P., Lu X., Kates S.L. Total knee arthroplasty volume, utilization, and outcomes among Medicare beneficiaries, 1991-2010. JAMA. 2012;308:1227.
    1. Lamplot J.D., Wagner E.R., Manning D.W. Multimodal pain management in total knee arthroplasty. J Arthroplasty. 2014;29(2):329.
    1. Moghtadaei M., Farahini H., Faiz S.H. Pain management for total knee arthroplasty: single-injection femoral nerve block versus local infiltration analgesia. Iran Red Crescent Med J. 2014;16(1):e13247.
    1. Pacira Pharmaceuticals, Inc. ; [accessed 4.11.2011].
    1. Gorfine S.R., Onel E., Patou G. Bupivacaine extended-release liposome injection for prolonged postsurgical analgesia in patients undergoing hemorrhoidectomy: a multicenter, randomized, double-blind, placebo-controlled trial. Dis Colon Rectum. 2011;54(12):1552.
    1. Golf M., Daniels S.E., Onel E. A phase 3, randomized, placebo-controlled trial of DepoFoam bupivacaine (extended-release bupivacaine local analgesic) in bunionectomy. Adv Ther. 2011;28(9):776.
    1. McPherson M.L. American Society of Health-System Pharmacists, Inc.; Bethesda, MD: 2009. Demystifying opioid conversion calculations: a guide for effective dosing.
    1. Essving P., Axelsson K., Kjellberg J. Reduced morphine consumption and pain intensity with local infiltration analgesia (LIA) following total knee arthroplasty. Acta Orthop. 2010;81(3):354.
    1. Busch C.A., Shore B.J., Bhandari R. Efficacy of periarticular multimodal drug injection in total knee arthroplasty: a randomized trial. J Bone Joint Surg Am. 2006;88:959.
    1. Richard B.M., Newton P., Ott L.R. The safety of EXPAREL® (bupivacaine liposome injectable suspension) administered by peripheral nerve block in rabbits and dogs. J Drug Deliv. 2012;2012:962101.
    1. Dasta J., Ramamoorthy S., Patou G., Sinatra R. Bupivacaine liposome injectable suspension compared with bupivacaine HCl for the reduction of opioid burden in the postsurgical setting. Curr Med Res Opin. 2012;28(10):1609.
    1. Bagsby D.T., Ireland P.H., Meneghini R.M. Liposomal bupivacaine versus traditional periarticular injection for pain control after total knee arthroplasty. J Arthroplasty. 2014;29(8):1687.
    1. Schroer W.C., Diesfeld P.G., LeMarr A.R., Morton D.J., Reedy M.E. Does extended-release liposomal bupivacaine better control pain than bupivacaine after TKA? A prospective, randomized clinical trial. J Arthroplasty. 2015;30(9):64.
    1. Kolisek F.R., McGrath M.S., Jessup N.M. Comparison of outpatient versus inpatient total knee arthroplasty. Clin Orthop Relat Res. 2009;467(6):1438.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться