title: Liposomal bupivacaine in forefoot surgery.
abstract: BACKGROUND
  Liposomal bupivacaine is increasingly being utilized in attempts to provide prolonged local analgesia in the immediate postoperative period. The purpose of this study was to quantify the reduction in opioid consumption as well as postoperative pain scores in the postoperative period when liposomal bupivacaine is used at the conclusion of forefoot surgery.
  
  
  METHODS
  This was a prospective therapeutic cohort study with 20 patients receiving liposomal bupivacaine at the conclusion of their forefoot procedure in addition to our routine multimodal analgesic protocol and 20 patients as the control without the addition of liposomal bupivacaine. Pain scores, number of narcotic pills consumed on postoperative days 1 through 4, need for refill, time to first refill and wound complications were evaluated.
  
  
  RESULTS
  Mean number of narcotic pills consumed on postoperative day 1 (1.4 vs 3.6, P = .002) and day 2 (1.8 vs 3.6, P = .021) was significantly lower for the liposomal bupivacaine group than the control group. Daily pain scores were lower for those patients who received liposomal bupivacaine on postoperative days 1 through 4, although this was not statistically significant. Fewer patients required medication refills in the liposomal bupivacaine group compared to the control group, however this was not statistically significant (3 vs 7, P = .273). There was no increase in wound complications in the liposomal bupivacaine group when compared to the control (1 vs 4).
  
  
  CONCLUSIONS
  Liposomal bupivacaine appears to be a useful adjunct in the treatment of postoperative pain when used as a part of a multimodal analgesic regimen in patients undergoing forefoot surgery.
  
  
  METHODS
  Level II, prospective comparative study.
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA justinrobbins80@yahoo.com.
authors.forename: Justin
authors.initials: J
authors.lastname: Robbins
authors.affiliation: Duke University School of Medicine, Department of Biostatistics and Bioinformatics, Durham, NC, USA.
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Green
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA Duke Fuqua School of Business, Durham, NC, USA.
authors.forename: Selene G
authors.initials: SG
authors.lastname: Parekh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D005260:Female; D005545:Forefoot, Human / Q000601:surgery*; D006215:Hallux Valgus / Q000601:surgery*; D006801:Humans; D008081:Liposomes; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000706:statistics & numerical data*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D011184:Postoperative Period; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D008081:Liposomes; D002045:Bupivacaine
keywords: analgesia; forefoot disorders; hallux disorders; liposomal bupivacaine; outcome studies; statistical analysis