Liposomal bupivacaine may reduce opioid consumption after rotator cuff repair
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Patients who received liposomal bupivacaine prior to closure during rotator cuff repair as part of a multimodal pain protocol had significantly reduced opioid consumption with no adverse events, readmissions or opioid-related side-effects compared with patients who did not receive liposomal bupivacaine, according to results.
Vani J. Sabesan, MD, and colleagues categorized 80 patients undergoing arthroscopic rotator cuff repair into groups based on whether they received a local infiltration of 20 mg liposomal bupivacaine as part of a multimodal pain management protocol. Researchers recorded patient-reported pain scores, opioid consumption and opioid-related side-effects at 24 and 72 hours and at 7 days postoperatively. Researchers converted opioid consumption to total morphine equivalents for comparison between groups.
Results showed an average pain score of 3.68 among patients who received liposomal bupivacaine vs. 8 in the control group on postoperative day 1. Researchers found 40% of patients in the liposomal bupivacaine group and 100% of patients in the control group reported taking an opioid medication. Patients in the liposomal bupivacaine group reported an average pain score of 1.6 by postoperative day 7, according to results. Researchers also noted 10% and 80% of patients in the liposomal bupivacaine group and control group, respectively, reported taking an opioid.
“When looking at the amount of opioids taken in the entire postoperative course, our liposomal bupivacaine group reported taking an average of 12.6 [total morphine equivalents] TMEs compared to 140 TMEs in the control group,” Sabesan, orthopedic surgeon at Cleveland Clinic Weston, told Healio Orthopedics. “This significant difference highlights that while we may not be able to eliminate opioid use completely with a multimodal protocol alone, we can significantly reduce the amount that patients consume.” – by Casey Tingle
Reference:
Sabesan VJ, et al. ePaper 593. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 24-28, 2020 (meeting canceled).
Disclosure: Sabesan reports that she receives research support from Arthrex Inc., Orthofix Inc. and Wright Medical Technology Inc.
Perspective
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Matthew J. DiPaola, MD
The opiate crisis in the United States has forced surgeons as a group to rethink postsurgical narcotic prescribing practices. Many surgeons have added liposomal bupivacaine to their multimodal perioperative pain protocol for shoulder surgery and a growing body of literature supports its use.
While I do not have personal experience with liposomal bupivacaine, I applaud the authors for executing this trial using both subjective and objective outcome measures. They present evidence that patients undergoing rotator cuff surgery who receive liposomal bupivacaine at the time of surgery may significantly decrease their overall opioid consumption postoperatively.
Not only did the authors demonstrate improved subjective pain scores at multiple time points in the liposomal bupivacaine group, they showed that the liposomal bupivacaine group used objectively less morphine equivalents and discontinued narcotic medications sooner than the control group.
Assuming that the two patient groups are matched well and the authors have minimized other potential biases/confounders, the study provides persuasive evidence that supports the use of liposomal bupivacaine in the perioperative period for rotator cuff patients.
One barrier that we and likely others face in making liposomal bupivacaine readily available to our patients remains its high cost. Not all formularies carry liposomal bupivacaine for this reason.
Jacobs School of Medicine
UBMD Orthopedics and Sports Medicine
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Sabesan VJ, et al. ePaper 593. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 24-28, 2020 (meeting canceled).
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