Liposomal Bupivacaine in Adductor Canal Blocks Before Total Knee Arthroplasty Leads to Improved Postoperative Outcomes: A Randomized Controlled Trial

Malige, Ajith; Pellegrino, Anna Ng; Kunkle, Kelcei; Konopitski, Andrew; Brogle, Patrick; Nwachuku, Chinenye

doi:10.1016/j.arth.2022.03.073

Cited by 15 publications

(23 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Fifteen trials investigated the efficacy of liposomal bupivacaine on peripheral nerve blocks, 18–21,24,27–29,32,33,36,38–40,42 while 12 explored its efficacy on field blocks 22,23,25,26,30,31,34,35,37,41,43,44 . Nerve block were performed under ultrasound guidance in 19 trials 18,20,22–24,27–36,38,39,43,44 and following anatomic landmarks in four studies 19,21,25,42 ; in another four studies, 26,37,40,41 the surgeon performed the block under direct vision. Liposomal bupivacaine doses ranged from 65 39 to 266 mg 22,23,25,26,28,33,35,37,41–44 .…”

Section: Resultsmentioning

confidence: 99%

The postoperative analgesic efficacy of liposomal bupivacaine versus long-acting local anaesthetics for peripheral nerve and field blocks

Nguyen

Grape

Gobbetti

et al. 2023

European Journal of Anaesthesiology

View full text Add to dashboard Cite

BACKGROUNDLiposomal bupivacaine is claimed by the manufacturer to provide analgesia for up to 72 h postoperatively.OBJECTIVESTo compare the postoperative analgesic efficacy of liposomal bupivacaine versus long-acting local anaesthetics for peripheral nerve or field blocks.DESIGNA systematic review and meta-analysis with trial sequential analysis.DATA SOURCESMEDLINE, Embase and Web of Science, among others, up to June 2022.ELIGIBILITY CRITERIAWe retrieved randomised controlled trials comparing liposomal bupivacaine versus bupivacaine, levobupivacaine or ropivacaine for peripheral nerve and field blocks after all types of surgery. Our primary endpoint was rest pain score (analogue scale 0 to 10) at 24 h. Secondary endpoints included rest pain score at 48 and 72 h, and morphine consumption at 24, 48 and 72 h.RESULTSTwenty-seven trials including 2122 patients were identified. Rest pain scores at 24 h were significantly reduced by liposomal bupivacaine with a mean difference (95% CI) of -0.9 (-1.4 to -0.4), I2 = 87%, P < 0.001. This reduction in pain scores persisted at 48 h and 72 h with mean differences (95% CI) of -0.7 (-1.1 to -0.3), I2 = 82%, P = 0.001 and -0.7 (-1.1 to -0.3), I2 = 80%, P < 0.001, respectively. There were no differences in interval morphine consumption at 24 h (P = 0.15), 48 h (P = 0.15) and 72 h (P = 0.07). The quality of evidence was moderate.CONCLUSIONSThere is moderate level evidence that liposomal bupivacaine reduces rest pain scores by 0.9 out of 10 units, when compared with long-acting local anaesthetics at 24 hours after surgery, and by 0.7 up to 72 hours after surgery.

show abstract

Section: Resultsmentioning

confidence: 99%

The postoperative analgesic efficacy of liposomal bupivacaine versus long-acting local anaesthetics for peripheral nerve and field blocks

Nguyen

Grape

Gobbetti

et al. 2023

European Journal of Anaesthesiology

View full text Add to dashboard Cite

show abstract

“…In addition, the study did not have equivalent anesthetic dosage between the LB and ROPI groups. [24] Klag et al was the only study to show LB increased postoperative LOS. However, the trial was not blinded to the participants and was ranked low quality by GRADE metrics.…”

Section: Grade Scoresmentioning

confidence: 96%

Intraoperative Liposomal Bupivacaine Does Not Reduce Opioid Use vs. Ropivacaine: A Systematic Review

2022

J Surg

View full text Add to dashboard Cite

Introduction: Liposomal bupivacaine (LB) is a long-acting analgesic that, due to its liposomal formulation, purportedly extends its analgesic effect up to 72 hours. However, the clinical efficacy of LB appears mixed. This systematic review seeks to evaluate the effectiveness of liposomal bupivacaine in improving postoperative outcomes compared to ropivacaine (ROPI), another commonly used long-acting analgesic. Materials and Methods:Prospective and randomized controlled trials (RCTs) evaluating the efficacy of LB compared to ROPI were selected for review. Primary outcomes included hospital length of stay (LOS) and postoperative opioid consumption measured in oral morphine equivalents (OME). Secondary outcomes included analgesic cost.Results: 14 studies met the review criteria. We found that LB and ROPI are equivalent in managing postoperative pain. 8 of the 14 trials reported equal efficacy between LB and ROPI as determined by OME post-procedure and 10 of the 14 trials reported similar LOS after surgery. These findings remained consistent across multiple surgical procedures and multiple drug administrative modalities. Conclusion:Our systematic review found that LB was not superior to ROPI in reducing postoperative OME use and hospital LOS. The only consistent finding was the significantly increased cost of LB compared to that of ROPI. Therefore, the use of LB over ROPI cannot be justified.

show abstract

“…A randomized study comparing liposomal bupivacaine and ropivacaine in adductor canal blocks, both in addition to an interspace between the popliteal artery and capsule of the posterior knee (iPACK) block using ropivacaine, showed that the liposomal bupivacaine group had significantly shorter length of stay, decreased inpatient opioid usage, and increased improvement in WOMAC scores after TKA 28 . However, another RCT showed no supporting evidence for the use of liposomal bupivacaine in adductor canal blocks for pain relief following TKA when compared with ropivacaine 29 .…”

Section: Anesthesia and Pain Managementmentioning

confidence: 99%

What’s New in Adult Reconstructive Knee Surgery

Villa

Singh

Higuera-Rueda

2022

Journal of Bone and Joint Surgery

View full text Add to dashboard Cite

Over the past year, areas of investigation in total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) such as bleeding control, thromboprophylaxis, pain management, technology-assisted surgery, and infection received major attention. We have included selected studies, many at the highest Levels of Evidence, in an attempt to summarize the most relevant recent findings. Economics of Added TechnologyAhmed et al. 1 evaluated the adoption of computer-assisted knee arthroplasty between the first quarter of 2010 and the third quarter of 2017 in the states of New York and Florida, making use of 2 statewide administrative databases (the Statewide Planning and Research Cooperative System in New York and the Florida Administrative Data in Florida). The proportion of computerassisted knee arthroplasty increased from 4.89% to 9.45% in New York, and from 4.03% to 5.73% in Florida. In New York, that represented a 93.3% growth in utilization. One of the reasons preventing the widespread adoption of these new technologies is their increased costs. In a Markov model, Rajan et al. 2 ascertained the cost-effectiveness of robotic-assisted TKA compared with conventional TKA. Robotic-assisted TKA produced 13.55 qualityadjusted life-years (QALYs) compared with 13.29 QALYs for conventional TKA. Because of its higher QALYs, robotic-assisted TKA remains cost-effective despite being associated with higher costs as long as annualized revision rates stay <1.6%. The costutility of patient-specific instrumentation for TKA compared with the standard of care among patients with a body mass index (BMI) of >30 kg/m 2 was evaluated; patient-specific instrumentation was more costly and less effective 3 . A secondary analysis of a randomized clinical trial (RCT) comparing closed-incision, negative-pressure therapy with the standard of care after revision TKA revealed that the total per-patient costs for surgical-site management were $1,047 for closed-incision, negative-pressure therapy and $2,036 for the standard of care 4 . Knee OsteoarthritisGenetic markers seem to play a role in advanced knee osteoarthritis. Utilizing clinical and genomic data, investigators showed that age and BMI contributed more to the risk of developing end-stage disease than genetic factors. However, 7 genetic loci were significantly associated with end-stage osteoarthritis. The effects of genetic factors were greater in patients who were <60 years of age 5 . The use of hyaluronic acid and platelet-rich plasma remains controversial. Among Medicare patients, hyaluronic acid utilization increased from 1,090,503 patients in 2012 to 1,209,489 patients in 2018 (p = 0.04), and total costs related to hyaluronic acid services increased from $290.10 million to $325.02 million (p < 0.01) 6 . In patients with hemophilic knee arthritis, a trial compared the effects of platelet-rich plasma injections with those of placebo on outcomes over a 24-month follow-up. There were no clinically important differences in the Western Ontario and McMaster Universities Osteoarthritis I...

show abstract

Liposomal Bupivacaine in Adductor Canal Blocks Before Total Knee Arthroplasty Leads to Improved Postoperative Outcomes: A Randomized Controlled Trial

Cited by 15 publications

References 35 publications

The postoperative analgesic efficacy of liposomal bupivacaine versus long-acting local anaesthetics for peripheral nerve and field blocks

The postoperative analgesic efficacy of liposomal bupivacaine versus long-acting local anaesthetics for peripheral nerve and field blocks

Intraoperative Liposomal Bupivacaine Does Not Reduce Opioid Use vs. Ropivacaine: A Systematic Review

What’s New in Adult Reconstructive Knee Surgery

Contact Info

Product

Resources

About