title: Local infiltration for postsurgical analgesia following total hip arthroplasty: a comparison of liposomal bupivacaine to traditional bupivacaine.
abstract: To assess postsurgical clinical and economic outcomes of patients who received local infiltration containing liposomal bupivacaine versus traditional bupivacaine for pain management following total hip arthroplasty (THA).
  
  
  
  This retrospective study included two groups of consecutive patients undergoing THA. The experimental group received local infiltration with a combination of liposomal bupivacaine, bupivacaine HCl 0.25% with epinephrine 1:200,000, and ketorolac for postsurgical analgesia. The historical control group received the previous standard of care: local infiltration with a combination of bupivacaine HCl 0.25% with epinephrine 1:200,000 and ketorolac. Key outcomes included distance walked, length of stay (LOS), opioid medication use, numeric pain scores, hospital charges, hospital costs, all-cause 30 day readmission rate, and adverse events (AEs). Both unadjusted and adjusted (i.e. age, sex, insurance type, living situation, body mass index, procedure side, and comorbidity) outcomes were compared between the two groups.
  
  
  
  The experimental group (n = 64) demonstrated statistically significant improvement versus the historical control group (n = 66) in mean distance walked on discharge day (249.2 vs. 180.0 feet; unadjusted p = .025, adjusted p = .070), mean LOS (2.0 vs. 2.7 days; p < .001, p = .002), proportion of patients who used opioid rescue medication on postoperative day (POD) 1 (29.7% vs. 56.1%; p = .002, p = .003) and POD 2 (7.8% vs. 30.3%; p = .001, p = .003), mean cumulative area under the curve for pain score on POD 0 (127.6 vs. 292.5; p < .001, both), POD 1 (92.9 vs. 185.0; p < .001, both), and POD 2 (93.8 vs. 213.8; p = .006, both). Among a subgroup of patients with available financial information, mean hospital charges were lower in the experimental group ($43,794 [n = 24] vs. $48,010 [n = 66]; p < .001, both). Rates of all-cause 30 day readmission and AEs were not significantly different between groups. No falls occurred.
  
  
  
  Infiltration at the surgical site with liposomal bupivacaine was associated with improved postsurgical outcomes when compared with traditional bupivacaine in patients undergoing THA.
authors.affiliation: a Center for Outcomes Research, University of Illinois College of Medicine at Peoria , Peoria , IL , USA.|b Department of Pharmacy Systems, Outcomes & Policy , University of Illinois at Chicago College of Pharmacy , Chicago , IL , USA.
authors.forename: Carl V
authors.initials: CV
authors.lastname: Asche
authors.affiliation: c University of Illinois College of Medicine at Peoria , Peoria , IL , USA.
authors.forename: Jinma
authors.initials: J
authors.lastname: Ren
authors.affiliation: c University of Illinois College of Medicine at Peoria , Peoria , IL , USA.
authors.forename: Minchul
authors.initials: M
authors.lastname: Kim
authors.affiliation: d Unity Point-Proctor Hospital , Peoria , IL , USA.
authors.forename: Kate
authors.initials: K
authors.lastname: Gordon
authors.affiliation: a Center for Outcomes Research, University of Illinois College of Medicine at Peoria , Peoria , IL , USA.
authors.forename: Marie
authors.initials: M
authors.lastname: McWhirter
authors.affiliation: a Center for Outcomes Research, University of Illinois College of Medicine at Peoria , Peoria , IL , USA.
authors.forename: Carmen S
authors.initials: CS
authors.lastname: Kirkness
authors.affiliation: e Great Plains Orthopaedics , Peoria , IL , USA.
authors.forename: Brian T
authors.initials: BT
authors.lastname: Maurer
mesh_terms: D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D002045:Bupivacaine / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D007902:Length of Stay; D008081:Liposomes; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy*; D011184:Postoperative Period; D012189:Retrospective Studies
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D008081:Liposomes; D002045:Bupivacaine
keywords: Analgesia; arthroplasty; hip; hospital charges; length of stay; pain; patient readmission; postoperative; recovery of function; replacement