title: Liposomal Bupivacaine as an Adjunct to Postoperative Pain Control in Total Hip Arthroplasty.
abstract: Although pain management affects rehabilitation, length of stay, and functional outcome, an optimized pain management protocol has yet to be standardized. Opioids are the primary agent used to control acute postoperative pain; however, they are associated with a wide range of side effects. Liposomal bupivacaine (LB), a long-acting analgesic agent administered intraoperatively, has been introduced as a new modality to control pain for up to 72 hours after operation without affecting motor function.
  
  
  
  Six hundred eighty-six primary total hip arthroplasty (THA) patients, who received the standard THA pain management protocol, were compared to a cohort of 586 primary THA patients, who were treated with an additional intraoperative injection of LB. All other pain management parameters and standard of care were identical. Statistical significance was set at P ≤ .05.
  
  
  
  Although patient-reported pain scores were statistically similar, the LB cohort demonstrated a significant decrease in total narcotic use (P < .001), specifically up to postoperative day 2 (P = .016). Physical therapy milestones were significantly achieved to a greater degree (P < .001) in the LB cohort. Operation time and hospital cost were unaffected (P = .072 and .811, respectively); however, the LB cohort exhibited a decrease in length of stay by 0.31 days (P < .001) and improvement in discharge disposition to home (P = .017).
  
  
  
  LB is a valuable adjunct to our THA pain management protocol, as we strive to achieve improved patient outcomes, reductions in length of stay, and enhanced quality of THA care.
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, New York.
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Yu
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, New York.
authors.forename: Alessandra L
authors.initials: AL
authors.lastname: Szulc
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, New York.
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Walton
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, New York.
authors.forename: Roy I
authors.initials: RI
authors.lastname: Davidovitch
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, New York.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Bosco
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, New York.
authors.forename: Richard
authors.initials: R
authors.lastname: Iorio
mesh_terms: D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage*; D019644:Arthroplasty, Replacement, Hip; D002045:Bupivacaine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D007430:Intraoperative Care; D008081:Liposomes / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D059408:Pain Management; D010149:Postoperative Pain / Q000188:drug therapy*; D012189:Retrospective Studies
chemical_list: D000779:Anesthetics, Local; D008081:Liposomes; D002045:Bupivacaine
keywords: liposomal bupivacaine; narcotic usage; pain control; pain management; quality; total hip arthroplasty