Results show liposomal bupivacaine reduced opioid use after TKA

Use of liposomal bupivacaine after TKA had an estimated institutional cost savings of $27,000 per year.

In the first 24 hours after primary total knee arthroplasty, patients who received local infiltration of liposomal bupivacaine had a reduced use of opioids and antiemetics and improved postoperative pain, according to study results.

“Liposomal bupivacaine infiltration of the knee in the veteran population is a viable option as part of a multi-modal analgesic regimen,” Bryan Sakamoto, MD, PhD, of the Richard L. Roudebush Veterans Affairs Medical Center, in Indianapolis, told Orthopedics Today.

Reduction in opioid use

Sakamoto and his colleagues recorded the use of opioids after discharge from a post-anesthesia care unit among 199 patients who underwent primary total knee arthroplasty (TKA) at a Veterans Affair Medical Center and did or did not undergo implementation of liposomal bupivacaine (Pacira) for local infiltration.

Results showed a reduction in median opioid use in the first 24 hours after surgery among patients who received liposomal bupivacaine after primary TKA compared with those who did not receive liposomal bupivacaine. Patients who received liposomal bupivacaine had a reduction in patient-controlled analgesia (PCA).

In the first 24 hours after surgery and in the post-anesthesia care unit, researchers noted a reduction in the use of antiemetics among patients who received liposomal bupivacaine. Despite improved pain scores among patients who received liposomal bupivacaine, there were greater median pain scores 48 hours, 72 hours and 96 hours after surgery in patients who received liposomal bupivacaine. Overall, researchers estimated an institutional cost savings of $27,000 per year with the use of liposomal bupivacaine.

“We were able to show a reduction in both opioid and antiemetic usage in the first 24 hours after surgery, and of note with respect to institutional resources, we reduced the number of PCA units used by almost 50%, which resulted in significant cost savings,” Sakamoto said.

Patient differences

According to Sakamoto, the results of this study did not agree with previous studies, which have shown significant positive results with respect to post-anesthesia care unit turnover and patient discharge times with the use of liposomal bupivacaine, which highlights how different patient populations affect treatment outcomes.

“What came to light from our study was that comparing our veteran population with a private practice population is like comparing apples to oranges,” Sakamoto said.

“Initially, this research was undertaken because a substantial amount of liposomal bupivacaine was utilized at our facility, and the administration wanted to know if its use was cost effective. In addition, the use of this medication has never been examined in the Veterans Affairs medical system,” Sakamoto said.

He said, “Future research at our facility will examine whether the use of liposomal bupivacaine has the same cost-effective profile when used in the setting of other surgical procedures.” – by Casey Tingle

Reference:

Sakamoto B, et al. JAMA Surg. 2016;doi:10.1001/jamasurg.2016.3474.

For more information:

Bryan Sakamoto, MD, PhD, can be reached at Richard L. Roudebush Veterans Affairs Medical Center, 1481 W. 10th St., Indianapolis, IN 46202; email: bryan.sakamoto@va.gov.

Disclosure: Sakamoto reports no relevant financial disclosures.