The efficacy of local liposomal bupivacaine infiltration on pain and recovery after Total Joint Arthroplasty

Zhao, Baocheng; Ma, Xinlong; Zhang, Jinli; Ma, Jianxiong; Cao, Qing

doi:10.1097/md.0000000000014092

Cited by 13 publications

(6 citation statements)

References 28 publications

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“…Despite MMA protocols, which include periarticular injections, reproducible pain relief beyond the first 24 hours remains inconsistent, and a significant proportion of patients undergoing TKA still requires the use of opioids postoperatively. 1,9,25,26 In a phase 4 study (PILLAR), the use of liposomal bupivacaine 266 mg admixed with bupivacaine HCl 100 mg plus an MMA regimen resulted in a mean VAS AUC 12-48 score of 180.8 (primary end point). 20 More than 80% received >20 mg of opioid medication; the geometric mean total opioid consumption over 48 hours was 18.7 mg. 20 HTX-011, an extended-release dual-acting local anesthetic, is designed to provide analgesia for up to 72 hours and to reduce postoperative opioid consumption; it has been shown to provide superior pain relief compared with bupivacaine HCl following TKA.…”

Section: Discussionmentioning

confidence: 99%

HTX-011 in Combination with Multimodal Analgesic Regimen Minimized Severe Pain and Opioid Use after Total Knee Arthroplasty in an Open-Label Study

Lee

Berkowitz²,

Hacker

et al. 2022

J Knee Surg

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Total knee arthroplasty (TKA) can be associated with significant postoperative pain despite multimodal analgesic (MMA) protocols, and most patients require the use of opioids postoperatively. HTX-011 is a dual-acting local anesthetic containing bupivacaine and low-dose meloxicam in an extended-release polymer. In a prior randomized controlled trial (RCT), HTX-011 reduced pain and opioid use through 72 hours after TKA compared with bupivacaine hydrochloride. This open-label study (NCT03974932) evaluated the efficacy and safety of HTX-011 combined with an MMA regimen in patients undergoing TKA under spinal anesthesia. All patients received intraoperative HTX-011 (400 mg bupivacaine/12 mg meloxicam) in combination with an MMA regimen consisting of preoperative acetaminophen, celecoxib, and pregabalin and postoperative acetaminophen and celecoxib until discharge. Opioid rescue was allowed upon patient request for additional pain control. Pain scores, opioid consumption, discharge readiness, and adverse events were recorded. Fifty-one patients were treated. Compared with the prior RCT, HTX-011 with this MMA regimen further lowered pain scores and reduced opioid use. Mean patient-reported pain scores remained in the mild range, and 82% of patients or more did not experience severe pain at any individual time point through 72 hours after surgery. Mean total opioid consumption was low over 72 hours: 24.8 morphine milligram equivalents (1–2 tablets of oxycodone 10 mg/day). Approximately 60% of patients were ready for discharge by 12 hours, and 39% were discharged without an opioid prescription and did not call back for pain management. The treatment regimen was well tolerated, and no added risk was observed with the addition of MMA. HTX-011 with an MMA regimen reduced postoperative pain and opioid use following TKA.

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Section: Discussionmentioning

confidence: 99%

HTX-011 in Combination with Multimodal Analgesic Regimen Minimized Severe Pain and Opioid Use after Total Knee Arthroplasty in an Open-Label Study

Lee

Berkowitz²,

Hacker

et al. 2022

J Knee Surg

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“…19,20 A metaanalysis from Zhao and colleagues showed no difference in pain control and functional recovery when comparing liposomal bupivacaine and control. 21 In a randomized clinical trial, Schroer and colleagues matched liposomal bupivacaine against regular bupivacaine and found no difference in pain scores and similar narcotic use during hospitalization. 22 Studies evaluating liposomal bupivacaine have demonstrated postoperative benefits in pain relief and potential opioid consumption.…”

Section: Discussionmentioning

confidence: 99%

Reduction of Opioid Use With Enhanced Recovery Program for Total Knee Arthroplasty

Martell¹

2021

Federal Practitioner

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Background: Adequate pain control after total knee arthroplasty (TKA) is critically important to achieve early mobilization, shorten the length of hospital stay, and reduce postoperative complications. At Veterans Affairs North Texas Health Care System (VANTHCS) in Dallas, we implemented a multidisciplinary enhanced recovery after surgery (ERAS) protocol to deal with increasing length of stay and postoperative pain. We hypothesize that this protocol will reduce the overall opioid burden and decrease inpatient hospital length of stay in our TKA population. Methods: A retrospective review of all TKAs performed by a single surgeon at VANTHCS from 2013 to 2018 was conducted. A postoperative ERAS protocol was implemented in 2016. We compared perioperative opioid use and LOS between cohorts before and after protocol implementation. Results: Inpatient length of stay between cohorts was re-duced from 66.8 hours for the standard of care (SOC) period to 22.3 hours in the ERAS cohort. Inpatient opioid use measured by total oral morphine equivalent doses averaged 169.5 mg and 66.7 mg for SOC and ERAS cohorts, respectively (P = .0001). Intraoperative use of opioids decreased from 57.4 mg in the SOC cohort to 10.5 mg in the ERAS cohort (P = .0001). Postanesthesia care unit (PACU) opioid use decreased from 13.6 mg (SOC) to 1.3 mg (ERAS) (P = .0002). There was no significant difference in complications between cohorts (P = .09). Conclusions: Initiating a multidisciplinary ERAS protocol for TKA at VANTHCS significantly reduced inpatient length of stay and perioperative opioid use with no deleterious effects on complication rates. The ERAS protocol has major medical and financial implications for our unique VA population and the VA health care system.

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“…Several studies reported lower pain scores as the benefits of extended release bupivacaine exhibited promising results [12][13][14][15][16]. However, as usage grew, results of several randomized trials, made even devoted users skeptical as the data exhibited non-superior results when compared to other modalities [7][8][9][10]. As a result, many orthopaedic surgeons have moved away from use of liposomal bupivacaine citing high cost for no presumed benefit [9].…”

Section: Discussionmentioning

confidence: 99%

“…Recently, liposomal bupivacaine gained popularity due to its extended release and initial, promising results [6]. However, not long after popularity grew, a few randomized trials reported data noting non-superior results when comparing liposomal bupivacaine to other pain modalities (within an operating multi-modal pain protocol) [7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Risk factors for liposomal bupivacaine resistance after total hip or knee arthroplasties: a retrospective observational cohort in 237 patients

Buzin

Gianakos

et al. 2020

Patient Saf Surg

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Purpose: Liposomal bupivacaine demonstrated promise decreasing postoperative pain in total hip and total knee arthroplasty (THA/TKA). Some randomized trials have shown non-superior results; however, confounding variables were not accounted for in such analyses. This study attempts to determine risk factors associated with failure of pain management in patients receiving liposomal bupivacaine. Methods: Postoperative pain scores were collected following primary or revision arthroplasties between January 2016 and December 2017. Retrospective analysis of institutional total joint quality and outcomes registry was screened and patients undergoing primary or revision arthroplasties who completed a multi-modal pain management including liposomal bupivacaine were included in the study. Patients with a history of infection/ deviated from the institutional pain management protocol were excluded. Results: A total of 237 patients were included for analysis. Younger patients less than 64 years old had significantly higher pain scores between 0 and 12 h and > 24 h. Active smokers had significantly higher pain scores between 0 and 6 h and > 24 h. Patients with a history of opioid use/pain management had significantly higher pain scores at 6-12 h and 24-48 h. Regression analysis indicated risk factors for resistance to liposomal bupivacaine are younger patients less than 64 years old, those undergoing primary THA, and patients with a history of smoking/pain management/opioid use. Conclusion: We identify risk factors for resistance to liposomal bupivacaine, which include younger age less than 64 years old, history of smoking/pain management/opioid use. Future studies should use these risk factors as exclusion criteria when using liposomal bupivacaine or initiating any randomized trials regarding efficacy.

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The efficacy of local liposomal bupivacaine infiltration on pain and recovery after Total Joint Arthroplasty

Cited by 13 publications

References 28 publications

HTX-011 in Combination with Multimodal Analgesic Regimen Minimized Severe Pain and Opioid Use after Total Knee Arthroplasty in an Open-Label Study

HTX-011 in Combination with Multimodal Analgesic Regimen Minimized Severe Pain and Opioid Use after Total Knee Arthroplasty in an Open-Label Study

Reduction of Opioid Use With Enhanced Recovery Program for Total Knee Arthroplasty

Risk factors for liposomal bupivacaine resistance after total hip or knee arthroplasties: a retrospective observational cohort in 237 patients

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