Evaluation of the Efficacy of Liposomal Bupivacaine in Total Joint Arthroplasty

Abstract

Background: Appropriate pain control is one of the cornerstones necessary to promote positive clinical outcomes. A new bupivacaine liposomal formulation was designed to extend its analgesic effect for up to 72-hours post-surgery, reportedly leading to significant opioid-sparing. Method: Retrospective and prospective chart review conducted in a 178-bed academic institution between January 2013 to December 2013 and August 2014 to November 2014, in 115 patients that receive hip and knee arthroplasty. The primary outcome was the measurement of average daily pain score on post-operative days 1 and 2. Secondary outcomes included length of stay, overall opioid use post-surgery and pain control satisfaction using Press-Ganey® scores. Results: The average pain scores in the HCl group were 4.64 and 4.38 (Likert score: 0-10) for POD 1 and POD 2, compared to 4.72 POD 1 and 4.2 POD 2 in the liposome group (POD 1: p = 0.413; POD 2: p = 0.303). The difference in LOS for knee arthroplasty was statistically significant [HCl group: 1.94 days (± 0.66) versus liposome group: 2.27 days (±0.77) p-value = 0.038)] favoring the standard of care. For hip arthroplasty or bilateral knee arthroplasty the differences in LOS were not statistically significant ( p = 0.052 and p = 0.484 respectively). 93% of the patients in the HCl group, pain was well controlled, versus 88.5% in the liposome group with similar oxycodone IR use among groups. Conclusion: Liposome bupivacaine did not offer a notable benefit compared to the HCl formulation in our study.

Transmuscular Quadratus Lumborum and Lateral Femoral Cutaneous Nerve Block in Total Hip Arthroplasty

“…PNB catheters18 and adjuvants that can prolong the pain relief provided by single-shot local anesthetic peripheral nerve blocks have been used for better management of acute and subacute pain after THA. Liposomal bupivacaine has been used with some efficacy; however, there is a discrepancy between the manufacturer reported efficacy of 72 hours and what the current data support 19,20. DEX is a commonly adopted local anesthetic adjuvant to instantly augment block quality and prolong analgesic duration for about 6 to 8 hours 21.…”

“…Liposomal bupivacaine has been used with some efficacy; however, there is a discrepancy between the manufacturer reported efficacy of 72 hours and what the current data support. 19,20 DEX is a commonly adopted local anesthetic adjuvant to instantly augment block quality and prolong analgesic duration for about 6 to 8 hours. 21 The mechanism of action of perineural DEX in nerve blocks is not yet clearly revealed but literature has shown that perineural DEX has a vasoconstrictive effect and reduces regional blood flow without causing ischemia.…”

Análise de prontuários dos pacientes acometidos por dor residual crônica após cirurgia de quadril com terapia medicamentosa

“…A osteomielite é uma infecção do tecido ósseo, sua abordagem cirúrgica ocorre quando o tratamento clínico não apresenta os resultados desejados ou ainda quando se faz necessário drenagem de abcessos. O tratamento é associado à antibioticoterapia e a maioria dos pacientes respondem a eficácia terapêutica (Zamora et al, 2021). A luxação congênita do quadril se caracteriza por perda do contato da cabeça do fêmur com o acetábulo, geralmente se manifesta ainda antes do nascimento, neste contexto, quanto mais tardio o diagnóstico, mais complexo o seu tratamento, uma das complicações mais invasivas é a necrose da cabeça do fêmur, decorrente da cessação do fluxo arterial local, o que pode ser decorrente de traumas, formação de êmbolos (corpos estranhos intravasculares ou intra arteriais) ou doenças que causam estenoses (estreitamentos) arteriais (Sinatra, 2010;Turesson et al, 2018).…”