Cost-benefit evaluation of liposomal bupivacaine in the management of patients undergoing total knee arthroplasty.
OBJECTIVE
Results of a cost-benefit analysis of intraoperative use of liposomal bupivacaine for postsurgical pain management in patients undergoing total knee arthroplasty (TKA) are presented.


METHODS
In a retrospective single-site study, clinical and cost outcomes were compared in a group of 134 consecutive patients who received liposomal bupivacaine (by local infiltration) during TKA and a propensity score-matched historical cohort of 134 patients undergoing TKA who received usual care (continuous femoral nerve blockade with conventional bupivacaine delivered via elastomeric pump).


RESULTS
Postsurgical pain scores and opioid use were similar in the two study groups; the mean total amount of nonsteroidal antiinflammatory drugs administered was lower in the liposomal bupivacaine group. Patients who received liposomal bupivacaine typically ambulated earlier than those who received usual care (22% and 3%, respectively, walked on the day of surgery; p < 0.05) and were more likely to be discharged within two days (50% versus 19%, p < 0.001); on average, liposomal bupivacaine- treated patients walked farther on the day of surgery (6.0 m versus 3.1 m, p < 0.001) and the day after surgery (63.7 m versus 25.5 m, p < 0.001) and had a shorter length of stay (LOS) (3.1 days versus 3.6 days, p < 0.03). The mean adjusted total direct hospital cost per patient was significantly lower with liposomal bupivacaine use versus usual care ($8758 versus $9213, p = 0.033).


CONCLUSIONS
In patients undergoing TKA, intraoperative administration of liposomal bupivacaine for management of postsurgical pain was found to offer advantages over usual care, including decreased time to ambulation and reduced hospital LOS.
Center for Outcomes Research and Department of Medicine, University of Illinois College of Medicine, Peoria, IL.
Carmen S
CS
Kirkness
Center for Outcomes Research, University of Illinois College of Medicine, Peoria, IL, and Department of Pharmacy Systems, Outcomes & Policy, University of Illinois at Chicago College of Pharmacy, Chicago, IL. aschecv@gmail.com.
Carl V
CV
Asche
Center for Outcomes Research, University of Illinois College of Medicine, Peoria, IL.
Jinma
J
Ren
Center for Outcomes Research, University of Illinois College of Medicine, Peoria, IL.
Minchul
M
Kim
OSF Saint Francis Medical Center, Peoria, IL.
Edward C
EC
Rainville
D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000191:economics*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000191:economics*; D002045:Bupivacaine / Q000008:administration & dosage / Q000191:economics*; D003362:Cost-Benefit Analysis / Q000379:methods*; D005260:Female; D006801:Humans; D008081:Liposomes; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000191:economics* / Q000379:methods; D010149:Postoperative Pain / Q000191:economics* / Q000517:prevention & control; D012189:Retrospective Studies
D000779:Anesthetics, Local; D008081:Liposomes; D002045:Bupivacaine