Liposomal Bupivacaine as a Single-Injection Peripheral Nerve Block

Background and objectivesMusic medicine is a non-pharmacologic intervention that is virtually harm-free, relatively inexpensive and has been shown to significantly decrease preoperative anxiety. In this study we aim to compare the use of music to midazolam as a preoperative anxiolytic prior to the administration of an ultrasound-guided single-injection peripheral nerve block.MethodsIn this randomized controlled study we compared the anxiolytic effects of intravenous midazolam (1–2 mg) with noise-canceling headphone-delivered music medicine. All patients received a preoperative ultrasound-guided single-injection peripheral nerve block indicated for a primary regional anesthetic or postoperative analgesia.ResultsThe change in the State Trait Anxiety Inventory-6 (STAI-6) anxiety scores from after to before the procedure were similar in both groups (music group −1.6 (SD 10.7); midazolam group −4.2 (SD 11); p=0.14; mean difference between groups −2.5 (95% CI −5.9 to 0.9), p=0.1). Patient satisfaction scores with their procedure experience were higher in the midazolam group (p=0.01); however, there were no differences in physician satisfaction scores of their procedure experience between groups (p=0.07). Both patient and physician perceptions on difficulties in communication were higher in the music group than in the midazolam group (p=0.005 and p=0.0007, respectively).ConclusionsMusic medicine may be offered as an alternative to midazolam administration prior to peripheral regional anesthesia. However, further studies are warranted to evaluate whether or not the type of music, as well as how it is delivered, offers advantages over midazolam that outweigh the increase in communication barriers.Clinical trial registryClinicaltrials.gov #NCT03069677

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Liposomal Bupivacaine Does Not Reduce Inpatient Opioid Prescription or Related Complications after Knee Arthroplasty

Anesthesiology ◽

10.1097/aln.0000000000002267 ◽

2018 ◽

Vol 129 (4) ◽

pp. 689-699 ◽

Cited By ~ 13

Author(s):

Lukas Pichler ◽

Jashvant Poeran ◽

Nicole Zubizarreta ◽

Crispiana Cozowicz ◽

Eric C. Sun ◽

...

Keyword(s):

Length Of Stay ◽

Peripheral Nerve ◽

Resource Utilization ◽

Nerve Block ◽

Knee Arthroplasty ◽

Peripheral Nerve Block ◽

Total Knee Arthroplasties ◽

Opioid Prescription ◽

Liposomal Bupivacaine ◽

Total Knee

Abstract Editor’s Perspective What We Already Know about This Topic What This Manuscript Tells Us That Is New Background Although some trials suggest benefits of liposomal bupivacaine, data on real-world use and effectiveness is lacking. This study analyzed the impact of liposomal bupivacaine use (regardless of administration route) on inpatient opioid prescription, resource utilization, and opioid-related complications among patients undergoing total knee arthroplasties with a peripheral nerve block. It was hypothesized that liposomal bupivacaine has limited clinical influence on the studied outcomes. Methods The study included data on 88,830 total knee arthroplasties performed with a peripheral nerve block (Premier Healthcare Database 2013 to 2016). Multilevel multivariable regressions measured associations between use of liposomal bupivacaine and (1) inpatient opioid prescription (extracted from billing) and (2) length of stay, cost of hospitalization, as well as opioid-related complications. To reflect the difference between statistical and clinical significance, a relative change of −15% in outcomes was assumed to be clinically important. Results Overall, liposomal bupivacaine was used in 21.2% (n = 18,817) of patients that underwent a total knee arthroplasty with a peripheral nerve block. Liposomal bupivacaine use was not associated with a clinically meaningful reduction in inpatient opioid prescription (group median, 253 mg of oral morphine equivalents, adjusted effect −9.3% CI −11.1%, −7.5%; P < 0.0001) and length of stay (group median, 3 days, adjusted effect −8.8% CI −10.1%, −7.5%; P < 0.0001) with no effect on cost of hospitalization. Most importantly, liposomal bupivacaine use was not associated with decreased odds for opioid-related complications. Conclusions Liposomal bupivacaine was not associated with a clinically relevant improvement in inpatient opioid prescription, resource utilization, or opioid-related complications in patients who received modern pain management including a peripheral nerve block.

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