No Added Value With Liposomal Bupivacaine Following TKA With Peripheral Nerve Block

The use of liposomal bupivacaine after total knee arthroplasty with a peripheral nerve block may not result in reductions in inpatient intake of opioids, hospital length of stay, or opioid-related complications, according to a study published in Anesthesiology.

The Premier Healthcare Database was used to obtain de-identified data on 88,830 patients who had undergone total knee arthroplasties performed with the use of a peripheral nerve block in the United States between 2013 and 2016. Only those patients who received liposomal bupivacaine in a hospital where “state-of-the-art” pain management was routinely practiced were included in the study. Analyses focused on the associations between liposomal bupivacaine use and inpatient opioid prescriptions, hospital length of stay, hospitalization costs, and opioid-related complications (eg, respiratory, genitourinary, central nervous system, gastrointestinal, and naloxone use).

A total of 18,817 patients (21.2% of cases examined) were found to have received liposomal bupivacaine during a total knee arthroplasty with a peripheral nerve block. The patients were found to experience significant, but not clinically meaningful, reductions in overall inpatient opioid prescriptions in an adjusted analysis (adjusted effect, −9.3%; 95% CI, −11.1% to −7.5%; P <.0001). In addition, there were no clinically meaningful reductions in hospital length of stay (−8.8%; 95% CI, −10.1% to −7.5%; P <.0001). A nonsignificant increase in hospitalization costs was found to be associated with the use of liposomal bupivacaine in those patients (+2.2%; 95% CI, −0.1% to +4.6%; P =.0900) who were not found to experience reductions in opioid-related complications (P >.999 for all).

A limitation of the study was its retrospective design, which precluded determination of causal relationships between liposomal bupivacaine and the primary outcomes and measures.

“Given the number of recent publications that suggest a lack of benefit of the addition of liposomal bupivacaine to a multimodal regimen including a regional analgesic technique, its routine use should be carefully examined, especially given its relatively high cost.”

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Reference

Pichler L, Poeran J, Zubizarreta N, et al. Liposomal bupivacaine does not reduce inpatient opioid prescription or related complications after knee arthroplasty: A database analysis [published online May 21, 2018]. Anesthesiology. doi:10.1097/ALN.0000000000002267