A Prospective, Randomized Trial Comparing Liposomal Bupivacaine vs Fascia Iliaca Compartment Block for Postoperative Pain Control in Total Hip Arthroplasty.
Increasing demand for total hip arthroplasty (THA) in a climate of increasing focus on clinical outcomes, patient satisfaction, and cost has created a need for better acute postoperative pain control for patients. An ideal pain control method would have few side effects, decreased opioid consumption, improved pain control, early ambulation, and decreased hospital length of stay (LOS).



We performed a prospective randomized, controlled study involving 79 patients undergoing elective THA between June 2015 and February 2016. Forty patients received liposomal bupivacaine and 39 patients received a fascia iliaca compartment block (FICB). In addition, the medical records of 28 patients who underwent elective THA between May 2015 and December 2015 were retrospectively examined. The primary outcome was visual analog scale pain scores and the secondary outcomes were LOS and total opioid consumption. SPSS, version 22, was used to run 1-way analysis of variance with contrast and Mood's median test on the data.



There were statistically significant decreases in pain intensity (P = .019) and LOS (P = .041) in both the liposomal bupivacaine group and the FICB group compared with those in the retrospective control group. In addition, only the FICB group showed statistically significant decreased total opioid consumption compared with that in the retrospective group (P = .028).



Patients undergoing elective THA have decreased overall pain intensity and a shorter LOS with multimodal pain management regimen that includes either liposomal bupivacaine or FICB. Patients who received FICB required less overall total opioids than the control group.
Orthopaedic Surgery Department, Grandview Medical Center, Dayton, Ohio.
Molly A
MA
McGraw-Tatum
Orthopaedic Surgery Department, Grandview Medical Center, Dayton, Ohio.
Michael T
MT
Groover
Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio.
Nicole E
NE
George
Orthopaedic Surgery Department, Grandview Medical Center, Dayton, Ohio.
John S
JS
Urse
Ohio University Heritage College of Osteopathic Medicine, Dublin, Dublin, Ohio.
Victor
V
Heh
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D002045:Bupivacaine / Q000008:administration & dosage*; D005205:Fascia; D005260:Female; D006801:Humans; D007902:Length of Stay; D008081:Liposomes; D035002:Lower Extremity; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods / Q000706:statistics & numerical data*; D059408:Pain Management / Q000379:methods; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control*; D017060:Patient Satisfaction; D011446:Prospective Studies; D012107:Research Design; D012189:Retrospective Studies
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D008081:Liposomes; D002045:Bupivacaine
fascia iliaca compartment block; length of stay; liposomal bupivacaine; multimodal pain control; postoperative pain; total hip arthroplasty