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Liposomal bupivacaine, interscalene catheter had similar pain relief for total elbow arthroplasty
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NEW ORLEANS — Results presented at the American Shoulder and Elbow Surgeons Annual Meeting showed similar pain relief among patients who underwent total elbow arthroplasty and had either liposomal bupivacaine or an indwelling interscalene catheter. However, liposomal bupivacaine was linked with significantly fewer complications at less cost.
Thomas W. (Quin) Throckmorton, MD, and colleagues compared VAS, oral morphine-equivalent usage, complications and charges between 16 patients who received intraoperative liposomal bupivacaine injection and 28 patients who received an indwelling interscalene catheter following total elbow arthroplasty.
Although results showed equivalent pain relief between the two groups up to 12 weeks postoperatively, Throckmorton noted patients in the liposomal bupivacaine group required double the narcotics in the first 24 hours after surgery. The liposomal bupivacaine group also had a significantly greater oral morphine-equivalent usage at 24 hours postoperatively, but this later decreased, according to results.
“The liposomal bupivacaine group had about 600 mg less in the oral morphine-equivalent usage at 12 weeks,” Throckmorton said.
Compared with no complications in the liposomal bupivacaine group, he noted a 43% rate of complications in the interscalene catheter group, including respiratory failure, leaking pump/catheters, dislodged catheters, global hand or forearm paresthesia, and pain at the catheter site.
Liposomal bupivacaine also had an association with lower costs, according to Throckmorton, with use of liposomal bupivacaine costing about $345 per case vs. a cost of almost $1,500 for use of an interscalene catheter per case. – by Casey Tingle
Reference:
Thompson KM, et al. Paper #14. Presented at: American Shoulder and Elbow Surgeons Annual Meeting; Oct. 12-14, 2017; New Orleans.
Disclosure: Throckmorton reports he is a board or committee member of the American Academy of Orthopaedic Surgeons, the American Shoulder and Elbow Surgeons and the Mid-American Orthopaedic Association; is on the editorial or governing board for the American Journal of Orthopedics, the Journal of Orthopaedic Trauma, the Orthopedic Clinics of North American and the Techniques in Shoulder and Elbow Surgery; receives IP royalties from Biomet and Zimmer; is a paid consultant for Biomet and Zimmer; is a paid presenter or speaker for Biomet and Zimmer; receives stock or stock options for Gilead; and receives publishing royalties, financial or material support from Saunders/Mosby-Elsevier.