Liposomal Bupivacaine Data Show Lower Pain Scores, Decreased LOS

    More than 1.1 million total joint arthroplasty procedures are performed annually in the US. Postsurgical pain is typically managed with continuous regional nerve blocks and systemic opioids, which can be associated with unwanted side effects such as leg weakness and sedation, both of which increase the risk of falls.

    An alternative is periarticular injection (PAI) of pain medications, which has been shown to be an effective approach to controlling postsurgical pain while improving function and reducing the need for opioids.

    In a symposium at the American Academy of Orthopaedic Surgeons’ 2015 Annual Meeting in Las Vegas, John W. Barrington, MD, described his experience with the use of liposomal bupivacaine (EXPAREL; Pacira, Parsippany, New Jersey) for PAI in a study of more than 2,200 hip and knee replacement patients.

    Click the image above to hear Dr. Barrington’s comments about the study.

    The analysis, which builds on a smaller subset of data presented at the 2014 AAOS annual meeting, evaluated 2,248 patients who underwent hip or knee arthroplasty and received a standard well-established multimodal regimen including PAI:

    • Half of the patients received PAI with bupivacaine HCl, with or without ketorolac, and morphine
    • Half of patients received PAI with liposomal

    The primary outcomes measured were Visual Analog Scale (VAS) pain scores and the percent of VAS pain scores that were 0, meaning patients reported “no pain.” 

    In addition, length of stay, patient-reported satisfaction, and per patient costs for supplies and pharmaceuticals were compared between the 2 treatment groups.  

    Key findings associated with the use of liposomal bupivacaine included: 

    • Significantly lower pain scores (1.98 vs. 2.43, P<0.0001)
    • Greater percentage of patients reporting “no pain” for hip (57.3% vs. 43.4%, P<0.0001) and for knee (47.2% vs. 42.1%, P <0.0001)
    • Decreased length of stay for patients undergoing knee replacement (2.40 days vs. 2.69 days, P<0.001)
    • Improved Press Ganey overall satisfaction (98.3% vs. 96.7%; P=0.0221)
    • Average cost savings of $1,246 per patient, which resulted in an overall hospital savings of over $1.5 million, predominately attributed to eliminating the need for femoral nerve catheters, knee immobilizers, and patient controlled analgesia pumps to deliver IV opioids

    “Getting patients on their feet and moving is critical to optimizing long-term treatment outcomes after hip or knee surgery, and the ability to provide a single-dose long-lasting alternative to opioids and catheter-based regional nerve blocks—which can negatively impact ambulation and the patient recovery experience—is a major advantage for orthopedic patients,” Dr. Barrington said.

    “Our analysis found that the use of liposomal bupivacaine can improve both pain control and patient satisfaction, while resulting in a meaningful cost savings per patient.” 

    Producer: Susan Doan-Johnson; Director and Post Production: Charles Maynard