Liposomal bupivacaine yields no significant pain relief after hip hemiarthroplasty
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Key takeaways:
- Liposomal bupivacaine did not provide significant pain relief after hip hemiarthroplasty vs. control.
- The study population consisted of older patients who underwent hemiarthroplasty for a femoral neck fracture.
Compared with a control, liposomal bupivacaine did not provide effective pain management for older patients who undergo hemiarthroplasty for an intracapsular femoral neck fracture, according to published results.
Kevin K. Kang, MD, director of orthopedic trauma at Maimonides Medical Center in Brooklyn, New York, and colleagues randomly assigned 49 patients (aged 65 years and older) who underwent hip hemiarthroplasty for an isolated intracapsular femoral neck fracture to receive either a single intraoperative 40 mL injection of 0.25% bupivacaine hydrochloride (Marcaine, Pfizer) with 20 mL of liposomal bupivacaine (Exparel, Pacira Pharmaceuticals; n = 25) or a single intraoperative 40 mL injection of 0.25% bupivacaine hydrochloride with 20 mL of normal saline solution (n = 24).
According to the study, outcome measures included VAS pain scores, opioid consumption in morphine milligram equivalents (MMEs), delirium and time to ambulation with physical therapy. Follow-up was performed at 4 hours, 8 hours, 12 hours, 24 hours and 48 hours postoperatively.
Overall, Kang and colleagues found no significant differences between the liposomal bupivacaine group and the control group for any outcome measure. At 48-hour follow-up, average VAS pain score was 2.26 for the liposomal bupivacaine group and 2.7 for the control group, whereas total MMEs consumed were 11.73 for the liposomal bupivacaine group and 9.98 for the control group. Results also showed the liposomal bupivacaine group had a postoperative day of discharge of 4 days vs. 3.9 days in the control group.
“Given the higher cost of liposomal bupivacaine compared with standard postoperative pain modalities, it is worth questioning its use in the setting of geriatric hip fractures,” Kang and colleagues wrote in the study.
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