The Use of Exparel (Liposomal Bupivacaine) to Manage Postoperative Pain in Unilateral Total Knee Arthroplasty Patients

Surdam, Jonathan W.; Licini, David J.; Baynes, Nathan T.; Arce, Britney R.

doi:10.1016/j.arth.2014.09.004

Cited by 127 publications

(107 citation statements)

References 17 publications

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“…Common strategies involve injectable, drug eluting polymers in the form of microspheres [45] or micelles [46], but degradation products can be toxic [47], drug elution rate can fall below effective levels [46], and drug release can have low efficacy [46]. The gold standard for drug-incorporated polymers for treating PJI is antibiotic-eluting BC made of PMMA [13], which can only be used in limited load-bearing applications [48].…”

Section: Discussionmentioning

confidence: 99%

A fully functional drug-eluting joint implant

et al. 2017

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Despite advances in orthopedic materials, the development of drug-eluting bone and joint implants that can sustain the delivery of the drug and maintain the necessary mechanical strength in order to withstand loading has remained elusive. Here, we demonstrate that modifying the eccentricity of drug clusters and the percolation threshold in ultrahigh molecular weight polyethylene (UHMWPE) results in maximized drug elution and in the retention of mechanical strength. The optimized UHMWPE eluted antibiotic at a higher concentration for longer than the clinical gold standard antibiotic-eluting bone cement while retaining the mechanical and wear properties of clinically used UHMWPE joint prostheses. Treatment of lapine knees infected with Staphylococcus aureus with the antibiotic-eluting UHMWPE led to complete bacterial eradication and to the absence of detectable systemic effects. We argue that the antibiotic-eluting UHMWPE joint implant is a promising candidate for clinical trials.

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Section: Discussionmentioning

confidence: 99%

A fully functional drug-eluting joint implant

et al. 2017

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“…Surdam et al [23], in a randomized trial comparing FNB with liposomal bupivacaine, demonstrated no difference in total and mean overall ambulation distance after TKA. They did however report that patients receiving liposomal bupivacaine had a higher mean ambulation distance on POD 1 as well as a greater proportion ambulating on the day of surgery.…”

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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“…The opioid consumption of all experimental groups was measured by converting to morphine equivalent using conversion factors as indicated by Surdam et al (23). The VRS was determined verbally by the patient as a self-rated pain score, which corresponded to the degree of pain at rest (19).…”

Section: Measurement Of Various Parametersmentioning

confidence: 99%

Ketamine and bupivacaine attenuate post‑operative pain following total knee arthroplasty: A randomized clinical trial

Zhang¹,

Shi

Hong-feng

2018

Exp Ther Med

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Abstract. Total knee arthroplasty (TKA) is highly associated with post-operative pain. The present randomized trial aimed to explore the possible post-operative pain management by a different combination of analgesics or opioids (ketamine and bupivacaine) following TKA. A total of 84 patients were randomly divided into four groups. All subjects were anesthetized for TKA surgery and received post-operative pain management via intra-articular saline (control group; n=23), ketamine (2 mg/kg) infused with saline (ket group; n=21) bupivacaine (0.5 mg/kg) infused with saline (bupi group; n=20) or ketamine (2 mg/kg)+bupivacaine (0.5 mg/kg) infused with saline (ket+bupi group; n=20) at the end of the surgery. Additional, post-operative analgesia was infused with the aid of patient-controlled analgesia with morphine. A reduction in the levels of pain score (verbal rating scale and visual analog scale), opioid consumption, time of ambulation, hospital stay and adverse events were observed in the ket+bupi group compared with the other groups. Meanwhile, the satisfaction score and knee flexion degree were improved following treatment with the ket+bupi regimen. Therefore, the multimodal analgesic regimen (ket+bupi) may be useful in mitigating post-operative pain as and improving knee mobilization following TKA. IntroductionTotal knee arthroplasty (TKA) is the standard surgical procedure performed globally for patients with end-stage osteoarthritis (OA) or rheumatoid arthritis (RA) (1). Pain management or control following TKA is a crucial factor for the successful outcome of knee surgery as poorly controlled pain following TKA may lead to increased anxiety, morbidity or psychological disorders, prolong the overall recovery or healing process, and increased readmission rate (2,3). Several steps have been taken to control or manage post-operative pain management; however, 20-25% of patients who have undergone TKA still experience severe to moderate pain at 1 year following the procedure (chronic pain), which may be due to acute severe pain (inadequate post-operative pain management) that leads to chronic pain for many years (4,5).Therefore, controlling or managing post-operative pain following TKA may considerably improve quality of life by enhancing motility, reduce hospitalized days with fewer pulmonary or cardiac complications, and decrease morbidity and mortality rate (6). Currently, the usage of epidural analgesia, femoral nerve block, and cyclooxygenase-2 inhibitors are recommended for post-operative pain management following TKA. However, these drugs result in several adverse events such as nausea/vomiting, constipation, sedation, pruritus, and depression (7-9). A number of previous studies have indicated that a multimodal pain management strategy with femoral nerve block (combining different analgesic agents-holistic activity) are successfully used to manage post-operative pain following TKA owing to its opioid sparing activity (10,11). Among those analgesics morphine, ketamine, bupivacaine, acetaminophen, clonidine an...

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The Use of Exparel (Liposomal Bupivacaine) to Manage Postoperative Pain in Unilateral Total Knee Arthroplasty Patients

Cited by 127 publications

References 17 publications

A fully functional drug-eluting joint implant

A fully functional drug-eluting joint implant

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

Ketamine and bupivacaine attenuate post‑operative pain following total knee arthroplasty: A randomized clinical trial

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