Liposomal Bupivacaine as an Adjunct to Postoperative Pain Control in Total Hip Arthroplasty

• Published in: The Journal of arthroplasty 2016-07, Vol.31 (7), p.1510-1515
• Main Authors: Yu, Stephen W., MD, Szulc, Alessandra L., MA, Walton, Sharon L., MD, Davidovitch, Roy I., MD, Bosco, Joseph A., MD, Iorio, Richard, MD
• Format: Article
• Language: English
• Subjects: Aged; Anesthetics, Local - administration & dosage; Arthroplasty, Replacement, Hip; Bupivacaine - administration & dosage; Female; Humans; Injections, Intra-Articular; Intraoperative Care; liposomal bupivacaine; Liposomes - administration & dosage; Male; Middle Aged; narcotic usage; Orthopedics; pain control; Pain Management; Pain, Postoperative - drug therapy; quality; Retrospective Studies; total hip arthroplasty
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2016.01.004

Abstract Background 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. Methods 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. Results 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). Conclusion 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.