Liposomal Bupivacaine Versus Traditional Periarticular Injection for Pain Control After Total Knee Arthroplasty

Bagsby, Deren; Ireland, Phillip H.; Meneghini, R. Michael

doi:10.1016/j.arth.2014.03.034

Cited by 143 publications

(119 citation statements)

References 19 publications

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“…The limitations of that previous study, including the lack of standardized technique between surgeons, confounding medications/anesthesia protocols, and a nonrandomized design, have all been addressed in the current study design. The results of this study are to be contrasted with a retrospective, noncontrolled study by Bagsby et al [5], which reported that patients injected with liposomal bupivacaine had higher pain scores at discharge compared with those given traditional PAI (ropivacaine, morphine, and epinephrine). In their study, the finding of higher pain in patients given liposomal bupivacaine was observed in the period between the end of the first 24 hours after surgery and discharge.…”

Section: Study Flow Diagramcontrasting

confidence: 53%

“…This formulation has been associated with decreased postoperative pain in patients undergoing TJA [6]. However, early comparative studies either had major methodological flaws [5] or were adequately powered but lacked randomization or anesthesia/ injection protocol standardization [6]. We therefore undertook a multicenter, double-blind, three-arm, randomized controlled trial (RCT) to investigate the effectiveness of a liposomal bupivacaine-based PAI (Exparel) versus ropivacaine-based (Naropin; Fresenius Kabi USA, Lake Zurich, IL, USA) PAI with a third arm that included a morphine-based spinal (Duramorph; West-Ward Pharmaceuticals, Eatontown, NJ, USA) in controlling postoperative pain in patients undergoing TJA.…”

Section: Introductionmentioning

confidence: 99%

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No Difference in Early Analgesia Between Liposomal Bupivacaine Injection and Intrathecal Morphine After TKA

Barrington

Emerson

Lovald

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background Opioid analgesics have been a standard modality for postoperative pain management after total knee arthroplasty (TKA) but are also associated with increased risk of nausea, pruritus, vomiting, respiratory depression, prolonged ileus, and cognitive dysfunction.There is still a need for a method of anesthesia that can deliver effective long-term postoperative pain relief without incurring the high cost and health burden of opioids and nerve blocks. Questions/purposes (1) Is liposomal bupivacaine-based periarticular injection (PAI) more effective than morphinebased spinal anesthesia or ropivacaine-based PAI in

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Section: Study Flow Diagramcontrasting

confidence: 53%

Section: Introductionmentioning

confidence: 99%

No Difference in Early Analgesia Between Liposomal Bupivacaine Injection and Intrathecal Morphine After TKA

Barrington

Emerson

Lovald

et al. 2017

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

show abstract

“…The clinically related significance of the reduction in pain scores remains unclear; however, they found a reduction in opioid-related adverse events in patients receiving liposomal bupivacaine. Conversely, Bagsby et al [3], in a small retrospective trial comparing liposomal bupivacaine with a traditional periarticular injection for TKA, did not find differences in total narcotic use and furthermore reported worse overall pain scores with liposomal bupivacaine. In the absence of strong findings favoring FNB over liposomal bupivacaine, our data suggest that liposomal bupivacaine poses an advantage over FNB with the ability to provide equivalent pain control, decreased narcotic use, and elimination of an additional procedure, which can cause nerve injury, quadriceps-induced weakness, and in-hospital falls.…”

Section: Discussionmentioning

confidence: 99%

Pain Control and Functional Milestones in Total Knee Arthroplasty: Liposomal Bupivacaine versus Femoral Nerve Block

Szulc

Walton

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background Although pain management after total knee arthroplasty (TKA) affects rehabilitation, length of stay, and functional outcomes, pain management for patients undergoing TKA has yet to be standardized. Femoral nerve blocks (FNBs) are commonly used as an adjunct; however, these can result in transient quadriceps weakness and have been associated with in-hospital falls. Periarticular infiltration of liposomal bupivacaine has been recently introduced as a long-acting analgesic that can be administered without affecting motor function. Questions/purposes (1) Does periarticular liposomal bupivacaine compared with FNB result in improved pain control as measured by pain scores and narcotic consumption? (2) How do liposomal bupivacaine and FNB compare in terms of gait and stairclimbing milestones and the proportion of patients who experienced a fall in the hospital?Methods Between September 2013 and October 2014, a retrospective analysis was conducted involving 24 surgeons who performed a total of 1373 unilateral, primary TKAs. From September 2013 to April 2014, the routine approach to TKA pain management pathway consisted of preoperative administration of oral analgesics, intraoperative anesthesia (preferred spinal or general), an ultrasound-guided FNB, intraoperative analgesic cocktail injection, patient-controlled analgesia, and oral and IV narcotics for pain as needed. A total of 583 patients were included in this study group. Starting May 2014, FNBs were discouraged and there was department-wide adoption of liposomal bupivacaine. Liposomal bupivacaine became routinely used in all patients undergoing TKA with no other changes made to the multimodal analgesia protocol at that time, and 527 patients in this study group were compared with the FNB cohort. Chart review on a total of 1110 patients was conducted by a research assistant who was not participating in patient care. During the inpatient stay, pain scores during 8-hour intervals, narcotic use, and physical therapy milestones were compared. Results With the numbers available, we detected no clinically important difference in pain scores throughout the hospital stay; however, patients treated with liposomal bupivacaine consumed very slightly less narcotics overall (96 ± 62 versus 84 ± 73 eq mg of morphine; [95% confidence interval, 11-13 mg]; p = 0. Conclusions In the absence of strong data supporting FNB over liposomal bupivacaine, we have modified our TKA pain management protocols by adopting liposomal bupivacaine in lieu of FNBs, facilitating rapid rehabilitation while providing adequate pain control. Level of Evidence Level III, therapeutic study.

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“…Several retrospective studies reported that liposomal bupivacaine did not improve the quality of postoperative pain profiles, nor did it improve the quality of recovery of these patients [11] or was even worse than a cheaper PAI [2]. This also was true in chronic opioid users scheduled for TKA [16].…”

mentioning

confidence: 69%

CORR Insights®: No Difference in Early Analgesia Between Liposomal Bupivacaine Injection and Intrathecal Morphine After TKA

Richebé

Brulotte

2017

Clinical Orthopaedics &Amp; Related Research

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Liposomal Bupivacaine Versus Traditional Periarticular Injection for Pain Control After Total Knee Arthroplasty

Cited by 143 publications

References 19 publications

No Difference in Early Analgesia Between Liposomal Bupivacaine Injection and Intrathecal Morphine After TKA

No Difference in Early Analgesia Between Liposomal Bupivacaine Injection and Intrathecal Morphine After TKA

Pain Control and Functional Milestones in Total Knee Arthroplasty: Liposomal Bupivacaine versus Femoral Nerve Block

CORR Insights®: No Difference in Early Analgesia Between Liposomal Bupivacaine Injection and Intrathecal Morphine After TKA

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