Liposomal bupivacaine yielded no advantages to ropivacaine in TKA
Click Here to Manage Email Alerts
Published results showed use of liposomal bupivacaine during total knee arthroplasty had no advantages and a considerably higher cost compared with use of ropivacaine.
Benjamin M. Frye, MD, and colleagues categorized 242 patients undergoing TKA to receive either ropivacaine (n=88) or liposomal bupivacaine plus free bupivacaine (n=154). Researchers recorded VAS pain scores, narcotic requirements, distance walked, range of motion, length of stay, Knee Society Score and need for manipulation under anesthesia among all patients.
Results showed patients who received ropivacaine had a lower mean VAS pain score 23 to 32 hours postoperatively, mean VAS pain score during the entire hospitalization and length of stay compared with the liposomal bupivacaine group. Researchers found higher knee range of motion at 2 weeks among patients in the ropivacaine group, but no other statistically significant differences between the groups in the other outcome measures. However, ropivacaine had a considerably lower cost at $19.36 vs. $329.60 for liposomal bupivacaine, according to results.
“We are always striving to improve patient outcomes in total joint replacement. Promising new techniques and technologies need to be evaluated, especially when they carry a high cost,” Frye told Healio Orthopedics. “Liposomal bupivacaine has been touted as a ‘game changer’ with regard to perioperative pain control. This study shows equivalent or better outcomes with ropivacaine at a fraction of the cost.” – by Casey Tingle
Disclosures: The authors report no relevant financial disclosures.
Perspective
Back to Top
Andrew I. Spitzer, MD
This study is yet additional evidence in the growing body of literature suggesting no analgesic or functional benefit of liposomal bupivacaine in comparison to much cheaper, conventional local anesthetics when used for periarticular infiltration/injection after TKA. While this is a retrospective study with a number of potentially significant confounders, the authors admirably attempted to accurately match their comparison cohorts, especially relative to the onset of analgesia, which can be delayed by using liposomal bupivacaine alone. It is notable that “all outcomes tested with liposomal bupivacaine were either equivalent or inferior to those tested with ropivacaine,” suggesting, as the authors correctly conclude, that “liposomal bupivacaine offers no advantages over ropivacaine, and has a considerably higher cost” ($310.24 per injection). In an era of cost containment, bundled payments and outcomes-based reimbursement, the use of liposomal is cost prohibitive without obvious benefit.
Department of orthopedic surgery
Los Angeles
Read more about
Click Here to Manage Email Alerts