Comparison of Intraoperative Periarticular Injections versus Liposomal Bupivacaine as Part of a Multimodal Approach to Pain Management in Total Knee Arthroplasty

Abstract

Pain control in TKA with a multimodal pain management protocol was not improved with the addition of liposomal bupivacaine compared to the IOPA injection at a community hospital.

A Meta-Analysis Comparing Liposomal Bupivacaine and Traditional Periarticular Injection for Pain Control after Total Knee Arthroplasty

“…2). [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] Four studies 7,13,15,18 compared other groups in addition to liposomal bupivacaine and traditional PAI, so we selected only the data related to liposomal bupivacaine and traditional PAI for analysis. Finally, nine RCTs and seven nRCTs were included in our review (►Table 1).…”

“…The drugs used for PAI included ropivacaine or bupivacaine, epinephrine, and one type of opiate such as morphine. Ten studies 8,11,[13][14][15][16][17]19,20,22 used ropivacaine, six studies 7,9,10,14,18,21 used bupivacaine, and one study 12 used one of them (►Table 1). Notably, 10 studies 7-9,15,17-22 reported one or more of their authors have disclosed potential or pertinent con-flicts of interest, and almost all these studies were RCTs except one.…”

Liposomal Bupivacaine Versus Continuous Popliteal Sciatic Nerve Block in Total Ankle Arthroplasty

“…Other studies have found no difference in pain scores and narcotic consumption and cite concerns over increased cost. 3,29,33,42,43,45,47 Multiple prospective, randomized control trials have also not shown a significant improvement in pain scores or narcotic consumption following total knee arthroplasty. 1,12,24…”

“…Orthopedic surgeons have previously demonstrated the safety and efficacy of liposomal bupivacaine (LB) in knee, hip, and shoulder replacement, with varying conclusions. 1,3-6,8-13,15,22,24,28-30,33-36,41-45,47-49 Our group has previously shown the utility of LB in bunion and forefoot surgery and described a technique for administration during total ankle arthroplasty. 23,31,39 The purpose of our study was to compare postoperative pain scores, need for extended narcotic use, and complications following total ankle arthroplasty in patients receiving LB (Exparel) or CPSNB.…”

CORR Insights®: No Difference in Early Analgesia Between Liposomal Bupivacaine Injection and Intrathecal Morphine After TKA

“…Several retrospective studies reported that liposomal bupivacaine did not improve the quality of postoperative pain profiles, nor did it improve the quality of recovery of these patients [11] or was even worse than a cheaper PAI [2]. This also was true in chronic opioid users scheduled for TKA [16].…”