Impact of liposomal bupivacaine administration on postoperative pain in patients undergoing total knee replacement.
OBJECTIVE
To determine whether liposomal bupivacaine, a long-acting anesthetic indicated for single-dose wound infiltration to produce postoperative analgesia, has an impact on postoperative pain in patients undergoing total knee arthroplasties (TKAs).


METHODS
Single-center retrospective cohort study.


METHODS
Large tertiary and quaternary care hospital.


METHODS
A total of 120 adults who underwent TKA between March 1, 2013, and October 31, 2013; of those patients, 55 patients received an intraoperative dose of liposomal bupivacaine 266 mg (active treatment group), and 65 did not receive the drug (control group).


RESULTS
The primary end point was the mean area under the curve (AUC) of numeric rating scale (NRS) pain scores from the end of surgery to 48 hours after surgery. Secondary end points included measures of postoperative pain up to 24 hours after surgery, opioid consumption within 48 hours after surgery, duration of hospitalization, and ambulation distance from the end of surgery to discharge. No significant differences were noted in the primary or secondary end points between patients who received or did not receive an intraoperative dose of liposomal bupivacaine. The mean ± SD AUC of NRS pain scores was 199.59 ± 67.11 and 192.94 ± 70.41 for the liposomal bupivacaine and control groups, respectively (p=0.658). Use of adjunctive analgesics was higher among patients in the control group, particularly for those receiving celecoxib, pregabalin, and continuous regional ropivacaine infusions, which may have minimized any differences in pain control between the treatment groups.


CONCLUSIONS
Liposomal bupivacaine did not improve pain control in patients undergoing TKA when compared with historical management strategies; however, differences may have been obscured by increased utilization of adjunctive analgesics among patients in the control group.
Emory University Hospital, Atlanta, Georgia.
Sarah
S
White
Duke University Medical Center, Durham, North Carolina.
Cathy
C
Vaughan
Duke University Medical Center, Durham, North Carolina.
Doug
D
Raiff
Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina.
William
W
Eward
Duke University Medical Center, Durham, North Carolina.
Michael
M
Bolognesi
D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D002045:Bupivacaine / Q000008:administration & dosage / Q000627:therapeutic use*; D016022:Case-Control Studies; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008081:Liposomes; D008297:Male; D008875:Middle Aged; D059408:Pain Management; D010149:Postoperative Pain / Q000503:physiopathology / Q000517:prevention & control*; D012189:Retrospective Studies
D000700:Analgesics; D018712:Analgesics, Non-Narcotic; D000779:Anesthetics, Local; D008081:Liposomes; D002045:Bupivacaine
analgesia; liposomal bupivacaine; pain control; total knee arthroplasty; wound infiltration