A Prospective, Randomized Trial Comparing Liposomal Bupivacaine vs Fascia Iliaca Compartment Block for Postoperative Pain Control in Total Hip Arthroplasty

McGraw-Tatum, Molly A.; Groover, Michael T.; George, Nicole E.; Urse, John S.; Heh, Victor

doi:10.1016/j.arth.2017.02.019

Cited by 36 publications

(17 citation statements)

References 14 publications

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“…4 Among them is a nonopioid local anesthetic LB, which has recently been shown to reduce the overall pain, hospital length of stay, and opioid consumption in patients having undergone nonspinal orthopaedic procedures, including total hip and knee arthroplasty. 21,22 Similar outcomes have also been documented in nonorthopedic cases, including hemorrhoidectomy, bunionectomy, and colorectal and retropubic slingplacement surgeries. 16,17,23,24 Despite these findings, the local anesthetic's effectiveness in reducing postoperative pain and opioid use in spine surgeries has not been well defined.…”

Section: Discussionmentioning

confidence: 57%

The Efficacy of Liposomal Bupivacaine in Lumbar Spine Surgery

Brown¹,

Weir²,

Shasti³

et al. 2018

Int J Spine Surg

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Background: Postoperative pain management in spine surgery holds unique challenges. The purpose of this study is to determine if the local anesthetic liposomal bupivacaine (LB) reduces the total opioid requirement in the first 3 days following posterior lumbar decompression and fusion (PLDF) surgery for degenerative spondylosis.Methods: Fifty patients underwent PLDF surgery in a prospective randomized control pilot trial between August 2015 and October 2016 and were equally allocated to either a treatment (LB) or a control (saline) group. Assessments included the 72-hour postoperative opioid requirement normalized to 1 morphine milligram equivalent (MME), visual analog scale (VAS), and hospital length of stay.Results: LB did not significantly alter the 72-hour postoperative opioid requirement compared to saline (11.6 vs. 13.4 MME, P ¼ .40). In a subgroup analysis, there was also no significant difference in opioid consumption among narcotic-naive patients with either LB or saline. Among narcotic tolerant patients, however, opioid consumption was higher with saline than LB (20.6 MME vs. 13.3 MME, P ¼ .048). Additionally, pre-and postoperative VAS scores and hospital length of stay were not significantly different with either LB or saline.Conclusions: In the setting of PLDF surgery, LB injections did not significantly reduce the consumption of opioids in the first 3 postoperative days, nor did the hospital length of stay or VAS pain scores, compared to saline. However, LB could be beneficial in reducing the consumption of opioids in narcotic-tolerant populations.Level of Evidence: 2.

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Section: Discussionmentioning

confidence: 57%

The Efficacy of Liposomal Bupivacaine in Lumbar Spine Surgery

Brown¹,

Weir²,

Shasti³

et al. 2018

Int J Spine Surg

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“…A slow-release mechanism involving reorganization of the barrier lipid membranes is sustained for up to 92 h with concomitant pain control for up to 72 h, as compared to 7-12 h with standard bupivacaine. Studies show bupivacaine decreased pain compared to placebo, the use of opioids and the hospital costs (Yeung et al 2018;Mazloomdoost et al 2017;Sabesan et al 2017;Declaire et al 2017;Smith et al 2017;Mcgraw-tatum et al 2017;Abildgaard et al 2017;Alijanipour et al 2016;Davidovitch et al 2017). Although the liposomal bupivacaine is not a nanoparticle (3-30 μm mean diameter), it is mentioned here because it is one of the most recent liposomal formulations approved.…”

Section: Pain Management: Bupivacainementioning

confidence: 99%

Nanomedicine review: clinical developments in liposomal applications

et al. 2019

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Background Many conventional drugs exhibit poor pharmacokinetics, limited bioavailability and a high toxicity, all of which restrain their use. To overcome these issues and improve the therapeutic indexes of the drug, the emergent fields of nanotechnology and nanomedicine have made significant progress in detection, diagnosis and treatment of several diseases at clinical level (Li et al. 2014; Yingchoncharoen et al. 2016; Signorell et al. 2018). In fact, thanks to nanoparticles and liposomes, it has been possible to decrease the toxicity and improve the pharmacokinetics parameters, such as distribution, increased circulation time, targeted controlled release, increased intracellular concentration, and

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“…Postoperative pain intensity was calculated using the area under the curve (AUC) for the VAS scores for the first 48 hours of inpatient stay (AUC ¼ P [Pain score Â Δtime]). 16…”

Section: Data Collectionmentioning

confidence: 99%

Pain Intensity: How Press Ganey Survey Domains Correlate in Total Knee Arthroplasty Patients

et al. 2018

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Decreasing postoperative pain for total knee arthroplasty (TKA) patients has been an area of continued effort for healthcare providers. These efforts have been incentivized by legislative reform, which ties reimbursement for hospitals and providers to patient perception of care. Press Ganey (PG) surveys quantify patient satisfaction, and the “pain management” domain is thought to be the best metric for assessing pain intensity. Therefore, these responses are important, as they are used to guide further improvements in healthcare delivery. This study analyzes which PG survey domains are truly associated with pain intensity in the immediate postoperative period following TKA. We queried our PG database for all primary TKA patients between November 2012 and January 2015, yielding a total of 214 patients. Multivariate regression analysis was performed utilizing pain intensity as the dependent variable. Predictor variables included body mass index (BMI), Charlson's comorbidity index, opioid consumption, and PG survey domains. Patient ratings of “communication with doctors” (B = 58.147; p = 0.001), “responsiveness of hospital staff” (B = − 62.663; p = 0.041), “communication about medicines” (B= −45.037; p < 0.001), and “hospital environment” (B = 69.342; p = 0.017) were associated with patient pain intensity. We found survey domains, other than “pain management,” were associated with pain intensity. Efforts to improve outcomes and satisfaction should focus on staff education and communication. The current method for measuring patient satisfaction and reimbursement should be critically assessed and redesigned to better reflect true patient experiences.

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A Prospective, Randomized Trial Comparing Liposomal Bupivacaine vs Fascia Iliaca Compartment Block for Postoperative Pain Control in Total Hip Arthroplasty

Cited by 36 publications

References 14 publications

The Efficacy of Liposomal Bupivacaine in Lumbar Spine Surgery

The Efficacy of Liposomal Bupivacaine in Lumbar Spine Surgery

Nanomedicine review: clinical developments in liposomal applications

Pain Intensity: How Press Ganey Survey Domains Correlate in Total Knee Arthroplasty Patients

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