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J Arthroplasty. 2016 Aug;31(8):1702-5. doi: 10.1016/j.arth.2016.01.037. Epub 2016 Jan 30.

Is There a Benefit for Liposomal Bupivacaine Compared to a Traditional Periarticular Injection in Total Knee Arthroplasty Patients With a History of Chronic Opioid Use?

Author information

1
Division of Adult Reconstruction, Department of Orthopaedic Surgery, NYU Langone Medical Center Hospital For Joint Diseases, New York, New York.
2
Division of Orthopaedic Surgery, Sorasky Medical Center, Tel Aviv University, Tel Aviv, Israel.
3
Department of Anesthesiology and Perioperative Care, University of California Irvine Medical Center, Orange, California.

Abstract

BACKGROUND:

Postoperative pain after total knee arthroplasty (TKA) poses a major challenge. It delays mobilization, increases opioid consumption and side effects, and lengthens hospitalization. This challenge multiplies when treating an opioid-dependent population. We examined whether a novel suspended release local anesthetic, liposomal bupivacaine (LB) would improve pain control and decrease opioid consumption after TKA compared to a standard periarticular injection in opioid-dependent patients.

METHODS:

Thirty-eight patients undergoing TKA were randomly assigned to receive either a periarticular injection (PAI) with LB (n = 20) or with a standard PAI (including a combination of ropivacaine, clonidine, Toradol, Epinepherine, and saline; n = 18) as part of a multimodal pain management approach. All periarticular injections were done by a single surgeon. Perioperative treatment was similar between groups. Postoperative information regarding pain level was evaluated by a pain visual analog scale score. Postoperative opioid consumption was recorded.

RESULTS:

After controlling baseline narcotic usage before surgery, no differences were found between groups in daily postoperative narcotic usage (P = .113), average daily pain score (P = .332), or maximum daily pain score (P = .881). However, when examining pain levels separately for each day, pain visual analog scale scores were reported higher in post operative day 1 in the LB group (P = .033).

CONCLUSIONS:

LB was not found to be superior to standard PAI in opioid-dependent patients undergoing TKA. This patient population continues to present a challenge even with modern multimodal pain protocols.

KEYWORDS:

liposomal bupivacaine; multimodal pain management; opioid dependence; periarticular injection; total knee arthroplasty

PMID:
26897490
DOI:
10.1016/j.arth.2016.01.037
[Indexed for MEDLINE]

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