Liposomal bupivacaine inferior to opioids for managing pain in TKA

The administration of liposomal bupivacaine in patients undergoing TKA, total knee arthroplasty is not associated with resource utilization, a clinically relevant improvement in inpatient opioid prescription, or opioid-related complications, according to a study published in the journal Anesthesiology.

The study was conducted by Lukas Pichler, from Weill Cornell Medical College in New York City, and colleagues to analyze the impact of liposomal bupivacaine use (regardless of administration route) on inpatient opioid prescription, resource utilization, and opioid-related complications among patients undergoing total knee arthroplasties with a peripheral nerve block.

Total knee arthroplasty (TKA) is among the most successful orthopedic procedures for the treatment of knee osteoarthritis and improving quality of life. However, the surgery is commonly associated with severe postoperative pain. The pain may result in delayed early mobilization, prolonged hospitalization and increased risk of postoperative complications. Therefore, adequate pain control after TKA is required for quicker recovery and reduced readmissions and treatment costs.

Liposomal bupivacaine (LB) is a long-acting local anesthetic reported to decrease postoperative pain in adults.

For the study, the researchers analyzed data on 88,830 total knee arthroplasties performed with a peripheral nerve block. Multilevel multivariable regressions measured associations between use of liposomal bupivacaine and (1) inpatient opioid prescription and (2) length of stay, cost of hospitalization, as well as opioid-related complications.

Liposomal bupivacaine was used in 21.2% (n = 18,817) of patients that underwent a total knee arthroplasty with a peripheral nerve block.

Key Findings:

• Liposomal bupivacaine use was not associated with a clinically meaningful reduction in inpatient opioid prescription and length of stay with no effect on cost of hospitalization.


• Liposomal bupivacaine use was not associated with decreased odds for opioid-related complications.

"Given the number of recent publications that suggest a lack of benefit of the addition of liposomal bupivacaine to a multimodal regimen, including a regional analgesic technique, its routine use should be carefully examined, especially given its relatively high cost," the authors write.

Based on the study, the authors concluded that liposomal bupivacaine was not associated with a clinically relevant improvement in inpatient opioid prescription, resource utilization, or opioid-related complications in patients who received modern pain management including a peripheral nerve block.

For further information click on the link: 10.1097/ALN.0000000000002267