Study: No benefit in pain relief, narcotic use seen with liposomal bupivacaine vs bupivacaine alone for TKA

DALLAS — A periarticular injection of liposomal bupivacaine prior to implantation of a total knee did not lead to a significant reduction in pain or decreased narcotic use compared with bupivacaine alone, according to results of a study presented at the American Association of Hip and Knee Surgeons Annual Meeting.

“A prospective, randomized periarticular trial of liposomal bupivacaine showed no improvement in pain management over plain bupivacaine,” William C. Schroer, MD, said during his presentation, here. “The cost associated with [liposomal bupivacaine] could not be supported by this study and it is no longer used in our multimodal pain management program.

William C. Schroer

In their IRB-approved trial, Schroer and his colleagues studied 111 consecutive unilateral primary total knee arthroplasties in which patients were randomized to receive either 20 mLs of liposomal bupivacaine and 30 mLs of plain bupivacaine (study group) or receive 60 mLs of plain bupivacaine (control group). A standard periarticular injection was performed in all cases utilizing a 22-gauge spinal needle.

“All patients were involved in our multimodal pain management program with about 15 different modalities to help prevent pain and nausea postoperatively,” Schroer said. The primary study endpoint was the Visual Analog Scale pain score and secondary measures included narcotic count, knee flexion and hospital length of stay.

“On postop day 1, day 2 and on the morning of day 3, we showed no difference between the study and control patients. Our narcotic use was equivalent between study and control patients, our hospital length of stay was equivalent and our disposition was the same — 97% of our patients went home directly, all but one of the study and two of the control patients.”

He noted liposomal bupivacaine cost his institution $285 compared with $2.80 for the control medication. — by Gina Brockenbrough, MA

Reference:

Schroer WC. Paper #2. Presented at: American Association of Hip and Knee Surgeons Annual Meeting; Nov. 7-9, 2014; Dallas.

Disclosure: Schroer is on the speakers bureau, is a paid consultant and has stock or stock options for Biomet; and is a paid consultant and receives research support as a primary investigator for Pfizer. No author received anything of value for participation in this study.