title: 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?
abstract: 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.
  
  
  
  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.
  
  
  
  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).
  
  
  
  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.
authors.affiliation: Division of Adult Reconstruction, Department of Orthopaedic Surgery, NYU Langone Medical Center Hospital For Joint Diseases, New York, New York.
authors.forename: Ran
authors.initials: R
authors.lastname: Schwarzkopf
authors.affiliation: Division of Orthopaedic Surgery, Sorasky Medical Center, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Michael
authors.initials: M
authors.lastname: Drexler
authors.affiliation: Department of Anesthesiology and Perioperative Care, University of California Irvine Medical Center, Orange, California.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Ma
authors.affiliation: Department of Anesthesiology and Perioperative Care, University of California Irvine Medical Center, Orange, California.
authors.forename: Vanessa M
authors.initials: VM
authors.lastname: Schultz
authors.affiliation: Department of Anesthesiology and Perioperative Care, University of California Irvine Medical Center, Orange, California.
authors.forename: Khanhvan T
authors.initials: KT
authors.lastname: Le
authors.affiliation: Division of Orthopaedic Surgery, Sorasky Medical Center, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Tal Frenkel
authors.initials: TF
authors.lastname: Rutenberg
authors.affiliation: Department of Anesthesiology and Perioperative Care, University of California Irvine Medical Center, Orange, California.
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Rinehart
mesh_terms: D000368:Aged; D000577:Amides / Q000008:administration & dosage; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage*; D019645:Arthroplasty, Replacement, Knee; D002045:Bupivacaine / Q000008:administration & dosage*; D003000:Clonidine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D008081:Liposomes / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000150:complications*; D059408:Pain Management / Q000379:methods; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D000077212:Ropivacaine; D016037:Single-Blind Method
chemical_list: D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D008081:Liposomes; D000077212:Ropivacaine; D003000:Clonidine; D002045:Bupivacaine
keywords: liposomal bupivacaine; multimodal pain management; opioid dependence; periarticular injection; total knee arthroplasty