Liposomal Bupivacaine Injection Technique in Total Knee Arthroplasty

R. Meneghini, Deren Bagsby, Philip H. Ireland, Mary Ziemba-Davis, Luke R. Lovro

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background Liposomal bupivacaine has gained popularity for pain control after total knee arthroplasty (TKA), yet its true efficacy remains unproven. We compared the efficacy of two different periarticular injection (PAI) techniques for liposomal bupivacaine with a conventional PAI control group. Methods This retrospective cohort study compared consecutive patients undergoing TKA with a manufacturer-recommended, optimized injection technique for liposomal bupivacaine, a traditional injection technique for liposomal bupivacaine, and a conventional PAI of ropivacaine, morphine, and epinephrine. The optimized technique utilized a smaller gauge needle and more injection sites. Self-reported pain scores, rescue opioids, and side effects were compared. Results There were 41 patients in the liposomal bupivacaine optimized injection group, 60 in the liposomal bupivacaine traditional injection group, and 184 in the conventional PAI control group. PAI liposomal bupivacaine delivered via manufacturer-recommended technique offered no benefit over PAI ropivacaine, morphine, and epinephrine. Mean pain scores and the proportions reporting no or mild pain, time to first opioid, and amount of opioids consumed were not better with PAI liposomal bupivacaine compared with PAI ropivacaine, morphine, and epinephrine. Conclusion Use of the manufacturer-recommended technique for PAI of liposomal bupivacaine does not offer benefit over a conventional, less expensive PAI during TKA.

Original languageEnglish (US)
JournalThe journal of knee surgery
DOIs
StateAccepted/In press - Feb 21 2016

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Knee Replacement Arthroplasties
Bupivacaine
Injections
Morphine
Opioid Analgesics
Epinephrine
Pain
Control Groups

Keywords

  • knee arthroplasty
  • liposomal bupivacaine
  • local analgesia
  • pain control
  • periarticular injection

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Liposomal Bupivacaine Injection Technique in Total Knee Arthroplasty. / Meneghini, R.; Bagsby, Deren; Ireland, Philip H.; Ziemba-Davis, Mary; Lovro, Luke R.

In: The journal of knee surgery, 21.02.2016.

Research output: Contribution to journalArticle

Meneghini, R. ; Bagsby, Deren ; Ireland, Philip H. ; Ziemba-Davis, Mary ; Lovro, Luke R. / Liposomal Bupivacaine Injection Technique in Total Knee Arthroplasty. In: The journal of knee surgery. 2016.
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AU - Lovro, Luke R.

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N2 - Background Liposomal bupivacaine has gained popularity for pain control after total knee arthroplasty (TKA), yet its true efficacy remains unproven. We compared the efficacy of two different periarticular injection (PAI) techniques for liposomal bupivacaine with a conventional PAI control group. Methods This retrospective cohort study compared consecutive patients undergoing TKA with a manufacturer-recommended, optimized injection technique for liposomal bupivacaine, a traditional injection technique for liposomal bupivacaine, and a conventional PAI of ropivacaine, morphine, and epinephrine. The optimized technique utilized a smaller gauge needle and more injection sites. Self-reported pain scores, rescue opioids, and side effects were compared. Results There were 41 patients in the liposomal bupivacaine optimized injection group, 60 in the liposomal bupivacaine traditional injection group, and 184 in the conventional PAI control group. PAI liposomal bupivacaine delivered via manufacturer-recommended technique offered no benefit over PAI ropivacaine, morphine, and epinephrine. Mean pain scores and the proportions reporting no or mild pain, time to first opioid, and amount of opioids consumed were not better with PAI liposomal bupivacaine compared with PAI ropivacaine, morphine, and epinephrine. Conclusion Use of the manufacturer-recommended technique for PAI of liposomal bupivacaine does not offer benefit over a conventional, less expensive PAI during TKA.

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KW - knee arthroplasty

KW - liposomal bupivacaine

KW - local analgesia

KW - pain control

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