TY - JOUR
T1 - Is There a Benefit for Liposomal Bupivacaine Compared to a Traditional Periarticular Injection in Total Knee Arthroplasty Patients With a History of Chronic Opioid Use?
AU - Schwarzkopf, Ran
AU - Drexler, Michael
AU - Ma, Michael W.
AU - Schultz, Vanessa M.
AU - Le, Khanhvan T.
AU - Rutenberg, Tal Frenkel
AU - Rinehart, Joseph B.
N1 - Publisher Copyright:
© 2016 Elsevier Inc.
PY - 2016/8/1
Y1 - 2016/8/1
N2 - Background Postoperative pain after total knee arthroplasty (TKA) poses a major challenge. It delays mobilization, increases opioid consumption and side effects, and lengthens hospitalization. This challenge multiplies when treating an opioid-dependent population. We examined whether a novel suspended release local anesthetic, liposomal bupivacaine (LB) would improve pain control and decrease opioid consumption after TKA compared to a standard periarticular injection in opioid-dependent patients. Methods Thirty-eight patients undergoing TKA were randomly assigned to receive either a periarticular injection (PAI) with LB (n = 20) or with a standard PAI (including a combination of ropivacaine, clonidine, Toradol, Epinepherine, and saline; n = 18) as part of a multimodal pain management approach. All periarticular injections were done by a single surgeon. Perioperative treatment was similar between groups. Postoperative information regarding pain level was evaluated by a pain visual analog scale score. Postoperative opioid consumption was recorded. Results After controlling baseline narcotic usage before surgery, no differences were found between groups in daily postoperative narcotic usage (P =.113), average daily pain score (P =.332), or maximum daily pain score (P =.881). However, when examining pain levels separately for each day, pain visual analog scale scores were reported higher in post operative day 1 in the LB group (P =.033). Conclusions LB was not found to be superior to standard PAI in opioid-dependent patients undergoing TKA. This patient population continues to present a challenge even with modern multimodal pain protocols.
AB - Background Postoperative pain after total knee arthroplasty (TKA) poses a major challenge. It delays mobilization, increases opioid consumption and side effects, and lengthens hospitalization. This challenge multiplies when treating an opioid-dependent population. We examined whether a novel suspended release local anesthetic, liposomal bupivacaine (LB) would improve pain control and decrease opioid consumption after TKA compared to a standard periarticular injection in opioid-dependent patients. Methods Thirty-eight patients undergoing TKA were randomly assigned to receive either a periarticular injection (PAI) with LB (n = 20) or with a standard PAI (including a combination of ropivacaine, clonidine, Toradol, Epinepherine, and saline; n = 18) as part of a multimodal pain management approach. All periarticular injections were done by a single surgeon. Perioperative treatment was similar between groups. Postoperative information regarding pain level was evaluated by a pain visual analog scale score. Postoperative opioid consumption was recorded. Results After controlling baseline narcotic usage before surgery, no differences were found between groups in daily postoperative narcotic usage (P =.113), average daily pain score (P =.332), or maximum daily pain score (P =.881). However, when examining pain levels separately for each day, pain visual analog scale scores were reported higher in post operative day 1 in the LB group (P =.033). Conclusions LB was not found to be superior to standard PAI in opioid-dependent patients undergoing TKA. This patient population continues to present a challenge even with modern multimodal pain protocols.
KW - liposomal bupivacaine
KW - multimodal pain management
KW - opioid dependence
KW - periarticular injection
KW - total knee arthroplasty
UR - http://www.scopus.com/inward/record.url?scp=84958212103&partnerID=8YFLogxK
U2 - 10.1016/j.arth.2016.01.037
DO - 10.1016/j.arth.2016.01.037
M3 - Article
AN - SCOPUS:84958212103
SN - 0883-5403
VL - 31
SP - 1702
EP - 1705
JO - Journal of Arthroplasty
JF - Journal of Arthroplasty
IS - 8
ER -