Improving total knee arthroplasty perioperative pain management using a periarticular injection with bupivacaine liposomal suspension

Mark A Snyder, Christina M Scheuerman, Justin L Gregg, Christopher J Ruhnke, Kathryn Eten, Mark A Snyder, Christina M Scheuerman, Justin L Gregg, Christopher J Ruhnke, Kathryn Eten

Abstract

Patients undergoing total knee arthroplasty (TKA) report low satisfaction with postoperative pain control. The purpose of this study is to examine if there is a difference in post-operative pain for TKA patients without femoral nerve block receiving an intra-operative pericapsular injection of bupivacaine liposome suspension (EXPAREL; Pacira Pharmaceuticals, Inc., San Diego, California) versus a concentrated multi drug cocktail. Seventy TKA patients were randomly assigned to either the bupivacaine liposome or the multi-drug cocktail. Post-operative pain scores, morphine sulfate equivalence consumption values, adverse events, and overall pain control satisfaction scores were collected. Patients reported significantly higher pain level for the cocktail group on post-op day 1 (p < .05) and post-op day 2 (p < .01) versus the bupivacaine liposome group. This same trend was found for morphine sulfate equivalence consumption in the PACU (p < .01) and post-op day 2 (p < .01). Higher satisfaction in pain control (p < .001) and overall experience (p < .01) was also found in the bupivacaine liposome group. Finally, significantly more adverse events were found in the multi-drug group versus the bupivacaine liposome group (p < .05). The study findings demonstrated a non-inferior difference, albeit not a clinically significant difference, in patient-perceived pain scores, morphine sulfate equivalence consumption, adverse events, and overall satisfaction.

Keywords: Pain; Pericapsular injection; Total knee arthroplasty.

Figures

Figure 1
Figure 1
CONSORT 2010 Bupivacaine Study Randomization Flow Diagram. This diagram displays the progress of all subjects throughout the study.
Figure 2
Figure 2
Subject Randomization Flowchart. This flowchart depicts how subjects were randomized at a 1:1 ratio to either the bupivacaine liposomal suspension injection or the concentrated cocktail mixture injection. Further detail shows the type of anesthesia each group received.

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