title: Liposomal bupivacaine in total hip arthroplasty: Do the results justify the cost?
abstract: BACKGROUND
  Liposomal bupivacaine has a paucity of data regarding narcotic requirements and hospital length of stay in comparison to other peri-articular injections, specifically in the total hip arthroplasty (THA) population.
  
  
  METHODS
  69 patients who underwent THA by a single surgeon were divided into two cohorts over a 3 year period in this retrospective study comparing narcotic requirements, hospital length of stay and cost. The study group (n = 29) received liposomal bupivacaine whereas a matched control group (n = 40) received a pharmacy-mixed cocktail in peri-articular structures. Statistical and clinical differences were reported in this unfunded study.
  
  
  RESULTS
  No difference was found in hospital length of stay [2.9 days in the study group (range 1-14) versus 3.1 days (range 1-11) in the control group, p = 0.101], however, the study group required less narcotics per day [22.6 mg (range 5-53.3) versus 29 mg (range 6.7-80.8) in the control group, p = 0.045]. The clinical difference between cohorts averaged less than one pill per day of hospitalization. The cost per patient of the local injection was more than 11 times greater in the liposomal bupivacaine group.
  
  
  CONCLUSIONS
  Liposomal bupivacaine demonstrated a statistical improvement in narcotic requirements but not in hospital length of stay in comparison to a control group. The effects of liposomal bupivacaine on narcotic requirements and hospital length of stay may not justify its use in total hip arthroplasty patients given the substantial cost of these injections and the minimal clinical difference in outcomes compared to a more cost-effective injection.
authors.affiliation: Department of Orthopaedic Surgery, San Antonio Military Medical Center, Joint Base San Antonio, TX 78234, USA.
authors.forename: Jason A
authors.initials: JA
authors.lastname: Beachler
authors.affiliation: Department of Orthopaedic Surgery, San Antonio Military Medical Center, Joint Base San Antonio, TX 78234, USA.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Kopolovich
authors.affiliation: Department of Orthopaedic Surgery, San Antonio Military Medical Center, Joint Base San Antonio, TX 78234, USA.
authors.forename: Creighton C
authors.initials: CC
authors.lastname: Tubb
authors.affiliation: South Texas Bone and Joint Institute, 5510B Presidio Parkway, Suite 2401, San Antonio, TX 78249, USA.
authors.forename: Siraj A
authors.initials: SA
authors.lastname: Sayeed
keywords: Length of stay; Liposomal bupivacaine; Narcotic requirement; THA cost