Efficacy of Liposomal Bupivacaine Compared with Multimodal Periarticular Injections for Postoperative Pain Control following Total Knee Arthroplasty

2018 ◽  
Vol 32 (10) ◽  
pp. 979-983 ◽  
Author(s):  
Tyler Britten ◽  
Jonathan D. Hughes ◽  
Yolanda Munoz Maldonado ◽  
Kirby D. Hitt
Keyword(s):  
Total Knee Arthroplasty ◽  
Postoperative Pain ◽  
Knee Arthroplasty ◽  
Wound Complications ◽  
Opioid Use ◽  
Liposomal Bupivacaine ◽  
Periarticular Injection ◽  
Pain Scores ◽  
Time Period ◽  
Total Knee

AbstractSingle-dose long-acting periarticular anesthetics have been shown to be an effective method of postoperative analgesia in total knee arthroplasty (TKA). This study retrospectively compares the efficacy of multimodal periarticular injection consisting of a combination of ropivacaine, duramorph, epinephrine, and toradol (HC) with liposomal bupivacaine (LB) periarticular injection in TKA. This study was a retrospective matched comparative chart review of two cohorts of patients who underwent TKA within a single health care system and cared for by one provider. We compared 22 patients who were treated with LB intraoperatively (LBG) with 41 matched controls who were treated with HC periarticular injection (HCG). These cases were retrospectively reviewed at 0 to 6, 6 to 12, 12 to 24, 24 to 48, and 48 to 72 hours. We reviewed pain scores and opioid use per the preceding time period, total opioid use, length of stay (LOS), and wound complications between the two groups. The two groups showed no statistical difference in total opioids used. In both the 6- to 12-hour and 12- to 24-hour intervals, the LBG required significantly more opioids than the HCG, with p-values of 0.0039 and 0.0061, respectively. Pain scores were not significantly different for any time period. We found no difference in LOS. The LBG tended to have lower doses of antiemetics than the HCG. No significant difference was found in postoperative pain scores and total opioid use between LB and multimodal periarticular intraoperative injections in TKA. Our data demonstrated decreased opioid consumption in the HC group compared with the LB group in both the 6- to 12-hour and 12- to 24-hour time intervals postoperatively. At our institution, LB costs US$314.99, whereas HC costs US$95.

Continuous Bupivacaine Infusion versus Liposomal Bupivacaine in Adductor Canal Block for Total Knee Arthroplasty

2021 ◽  
Author(s):  
Chang-Hwa Mary Chen ◽  
Andrew G. Yun ◽  
Teresa Fan
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Local Anesthetic ◽  
Recovery Room ◽  
Analysis Of Covariance ◽  
Opioid Use ◽  
Liposomal Bupivacaine ◽  
Adductor Canal ◽  
Pain Scores ◽  
Total Knee

AbstractMultimodal pain management for total knee arthroplasty (TKA) is essential to enhance functional recovery. Regional anesthesia became a vital component to decrease pain after TKA. Several studies compared femoral versus adductor canal blocks, including evaluating medications that can prolong adductor canal blocks. Liposomal bupivacaine (LB) and continuous local infusion (OnQ) both extend local anesthetic delivery beyond 24 hours. This superiority study compared the use of OnQ versus LB in adductor canal blocks. A retrospective study was conducted between two cohorts of consecutive patients who received adductor canal blocks with either LB or a continuous ropivacaine infusion catheter. Morphine equivalent dose (MED), pain scores, and length of stay (LOS) were compared between the two groups by using the analysis of covariance test. There were 106 patients in the OnQ group and 146 in the LB group. The OnQ group consumed significantly fewer opioids compared with the LB group in the recovery room (5.7 MED vs. 11.7 MED, p = 0.002) and over the entire hospitalization (the recovery room plus on the floor; 33.3 MED vs. 42.8 MED, p = 0.009). Opioid use between the OnQ and LB group did not reach statistical significance (p = 0.21). The average pain scores at rest and with activity were similar in both groups (p = 0.894, p = 0.882). The LOS between the OnQ and LB groups was not statistically significant (1.2 vs. 1.3, p = 0.462). OnQ and LB were equally effective in decreasing opioid consumption on the floor over the averaged 1.3 days of hospitalization; however, the OnQ group significantly reduced opioid use in the recovery room. There was no difference in pain scores or LOS between the two groups. OnQ comparatively prolonged infusion of local anesthetic is a potential edge over LB. This advantage may offset the inconvenience of catheter management and infrequent catheter complications.

A Three-arm Randomized Clinical Trial Comparing Continuous Femoral Plus Single-injection Sciatic Peripheral Nerve Blocks versus Periarticular Injection with Ropivacaine or Liposomal Bupivacaine for Patients Undergoing Total Knee Arthroplasty

2017 ◽  
Vol 126 (6) ◽  
pp. 1139-1150 ◽  
Author(s):  
Adam W. Amundson ◽  
Rebecca L. Johnson ◽  
Matthew P. Abdel ◽  
Carlos B. Mantilla ◽  
Jason K. Panchamia ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Peripheral Nerve ◽  
Nerve Block ◽  
Knee Arthroplasty ◽  
Nerve Blocks ◽  
Liposomal Bupivacaine ◽  
Periarticular Injection ◽  
Pain Scores ◽  
Average Pain ◽  
Total Knee

Abstract Background Multimodal analgesia is standard practice for total knee arthroplasty; however, the role of regional techniques in improved perioperative outcomes remains unknown. The authors hypothesized that peripheral nerve blockade would result in lower pain scores and opioid consumption than two competing periarticular injection solutions. Methods This three-arm, nonblinded trial randomized 165 adults undergoing unilateral primary total knee arthroplasty to receive (1) femoral catheter plus sciatic nerve blocks, (2) ropivacaine-based periarticular injection, or (3) liposomal bupivacaine-based periarticular injection. Primary outcome was maximal pain during postoperative day 1 (0 to 10, numerical pain rating scale) in intention-to-treat analysis. Additional outcomes included pain scores and opioid consumption for postoperative days 0 to 2 and 3 months. Results One hundred fifty-seven study patients received peripheral nerve block (n = 50), ropivacaine (n = 55), or liposomal bupivacaine (n = 52) and reported median maximal pain scores on postoperative day 1 of 3, 4, and 4.5 and on postoperative day 0 of 1, 4, and 5, respectively (average pain scores for postoperative day 0: 0.6, 1.7, and 2.4 and postoperative day 1: 2.5, 3.5, and 3.7). Postoperative day 1 median maximal pain scores were significantly lower for peripheral nerve blockade compared to liposomal bupivacaine-based periarticular injection (P = 0.016; Hodges–Lehmann median difference [95% CI] = −1 [−2 to 0]). After postanesthesia care unit discharge, postoperative day 0 median maximal and average pain scores were significantly lower for peripheral nerve block compared to both periarticular injections (ropivacaine: maximal −2 [−3 to −1]; P < 0.001; average −0.8 [−1.3 to −0.2]; P = 0.003; and liposomal bupivacaine: maximal −3 [−4 to −2]; P < 0.001; average −1.4 [−2.0 to −0.8]; P < 0.001). Conclusions Ropivacaine-based periarticular injections provide pain control comparable on postoperative days 1 and 2 to a femoral catheter and single-injection sciatic nerve block. This study did not demonstrate an advantage of liposomal bupivacaine over ropivacaine in periarticular injections for total knee arthroplasty.

Efficacy of Liposomal Bupivacaine versus Ropivacaine in Adductor Canal Block for Total Knee Arthroplasty

2020 ◽  
Author(s):  
Chang-Hwa Mary Chen ◽  
Andrew G. Yun ◽  
Teresa Fan
Keyword(s):  
Total Knee Arthroplasty ◽  
Pain Score ◽  
Knee Arthroplasty ◽  
Opioid Use ◽  
Adductor Canal Block ◽  
Liposomal Bupivacaine ◽  
Adductor Canal ◽  
Pain Scores ◽  
Average Pain ◽  
Total Knee

AbstractAdductor canal block (ACB) is advantageous for postoperative analgesia in total knee arthroplasty (TKA) because it results in minimal motor block. Liposomal bupivacaine (LB) is Food and Drug Administration-approved extended-release formulation of bupivacaine for interscalene peripheral nerve blocks. Its use is increasing in the TKA setting, mainly as a local infiltration agent. We compared the efficacy of ACB using LB versus ropivacaine in TKA. Two cohorts of patients were retrospectively analyzed at a single institution receiving ropivacaine and LB ACB for TKA. Duration of LB ACB, time to first opioid use postrecovery room, amount of opioid use postrecovery room, length of stay (LOS), and average and highest pain scores were collected. A total of 91 and 142 TKA patients received ropivacaine and LB for ACB, respectively. At 8 hours postrecovery room, more patients in the LB group required no opioids compared with the ropivacaine group (p = 0.026). Mean opioid consumption was lower in the LB group than in the ropivacaine group at 8 and 24 hours postrecovery room, although statistical significance was only observed at 8 hours (p = 0.022). The highest pain score for patients in the two groups was not statistically different. The average pain score for patients with a 2-day LOS was higher in the LB group, but average pain scores were similar for patients with 1- and 3-day LOS. Median LOS for the LB and ropivacaine groups was 1 and 2 days, respectively (p < 0.0001). Significantly lower opioid use at 8 hours postrecovery room was seen in the LB group compared with the ropivacaine group. There was no difference in opioid use at 24 and 48 hours. There was also no advantage with LB ACB in decreasing pain scores. However, the LB ACB group demonstrated a significantly shorter LOS compared with the ropivacaine ACB group.

scholarly journals Tranexamic Acid Increases Early Postoperative Pain and Decreases Time to First Opioid Following Total Knee Arthroplasty

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Sachin Seetharam ◽  
Sydney Keller ◽  
Mary Ziemba-Davis ◽  
R. Michael Meneghini MD
Keyword(s):  
Total Knee Arthroplasty ◽  
Postoperative Pain ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Ex Vivo ◽  
Pain Scores ◽  
Average Pain ◽  
Total Knee

Background and Hypothesis: Tranexamic acid (TXA) decreases blood loss in total knee arthroplasty (TKA). However, TXA evoked pain in rats by inhibiting GABA and glycine receptors in the spinal dorsal horn, and caused cellular death in ex vivo and in vitro human periarticular tissues exposed to clinical concentrations of TXA. We evaluated inpatient postoperative pain and blood loss in TKA performed with and without TXA. Project Methods: 105 consecutive cemented TKAs without TXA were compared to 72 consecutive cemented TKAs with TXA. Procedures were performed by a single surgeon using identical perioperative medical and pain-control protocols. Outcomes included: average of q2-4 hour pain scores during the first 24 hours after PACU discharge, average pain during remainder of stay, final pain score prior to discharge, time in minutes to first opioid after PACU discharge, total opioids in morphine equivalents (MEQs) during the first 24 hours after PACU discharge, average MEQs per remaining days of stay, and mean g/dL pre- to postoperative decrease in hemoglobin. Multivariate analyses accounted for 15 demographics and covariates. Results: The sex (p=0.393), age (p=0.784), and BMI (p=0.930) of the two cohorts were similar. Mean pain during the first 24 hours was greater (4.1 vs. 3.2, p=0.001), MEQs consumed during the first 24 hours were greater (45 vs. 37, p=0.069), and time to first opioid medication was shorter (326 vs. 414, p=0.023) in patients who received TXA. The decrease in hemoglobin was less in patients who received TXA (-2.2 vs. -2.7, p<0.001).   Conclusion and Potential Impact: Our hypothesis based on animal and laboratory studies that TXA may increase early postoperative pain was confirmed by three metrics. Consistent with the effective life of TXA, pain and opioid consumption after 24 hours did not differ based on TXA use. Further work is warranted to investigate the nature consequences associated with TXA, relative to its demonstrated benefits for blood conservation.  

Tourniquet Use in Total Knee Arthroplasty

2019 ◽  
Vol 32 (08) ◽  
pp. 719-729 ◽  
Author(s):  
Jaymeson R. Arthur ◽  
Mark J. Spangehl
Keyword(s):  
Total Knee Arthroplasty ◽  
Postoperative Pain ◽  
Knee Arthroplasty ◽  
Wound Complications ◽  
Evidence Based ◽  
Increased Risk ◽  
Negative Effect ◽  
Total Knee ◽  
Controversial Topic ◽  
Antibiotic Delivery

AbstractTourniquet use in total knee arthroplasty has become a controversial topic. There are several benefits of its use including improved visualization, decreased blood loss, shorter operative times, and improved antibiotic delivery. Conversely, there are several significant downsides associated with tourniquet use including postoperative pain, neuromuscular injuries, wound complications, reperfusion injury, increased risk of thrombosis, patellar tracking issues, delayed rehabilitation including decreased postoperative range of motion, and its negative effect on patients with vascular disease. However, objectively, the literature does not definitively push us toward or away from the use of a tourniquet. Furthermore, several alternatives have been developed to help mitigate some of the adverse effects associated with its use. This article summarizes the evidence for and against tourniquet use and provides an evidence-based approach to help guide surgeons in their own practice.

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