Liposomal bupivacaine reduces opioid consumption and length of stay in patients undergoing primary total hip arthroplasty

VanWagner, Michael J.; Krebs, Nathan M; Corser, William; Johnson, Christopher N.

doi:10.1177/1120700018778240

Cited by 9 publications

(14 citation statements)

References 11 publications

(22 reference statements)

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“…13,14,41 Commonly used medications include nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, alpha-II agonists (eg, clonidine), cyclooxygenase-2 inhibitors, gabapentinoids, N-methyl-d-aspartate receptor agonists (eg, ketamine), magnesium, liposomal bupivacaine, and corticosteroids. 1,11,12,20,44,47,64 Among 170 ASES members recently surveyed regarding pain management, 88% reported using a regional nerve block for RCR, while less than 40% and 20% used NSAIDs and acetaminophen, respectively, during the perioperative period. 65 More recently, there has been a growing emphasis placed on preoperative patient education of opioid use, adverse effects, and abuse.…”

Section: Discussionmentioning

confidence: 99%

Opioid Use After Common Sports Medicine Procedures: A Systematic Review

et al. 2020

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Context: The prescription of opioids after elective surgical procedures has been a contributing factor to the current opioid epidemic in North America. Objective: To examine the opioid prescribing practices and rates of opioid consumption among patients undergoing common sports medicine procedures. Data Sources: A systematic review of the electronic databases EMBASE, MEDLINE, and PubMed was performed from database inception to December 2018. Study Selection: Two investigators independently identified all studies reporting on postoperative opioid prescribing practices and consumption after arthroscopic shoulder, knee, or hip surgery. A total of 119 studies were reviewed, with 8 meeting eligibility criteria. Study Design: Systematic review. Level of Evidence: Level 4. Data Extraction: The quantity of opioids prescribed and used were converted to milligram morphine equivalents (MMEs) for standardized reporting. The quality of each eligible study was evaluated using the Methodological Index for Non-Randomized Studies. Results: A total of 8 studies including 816 patients with a mean age of 43.8 years were eligible for inclusion. A mean of 610, 197, and 613 MMEs were prescribed to patients after arthroscopic procedures of the shoulder, knee, and hip, respectively. At final follow-up, 31%, 34%, and 64% of the prescribed opioids provided after shoulder, knee, and hip arthroscopy, respectively, still remained. The majority of patients (64%) were unaware of the appropriate disposal methods for surplus medication. Patients undergoing arthroscopic rotator cuff repair had the highest opioid consumption (471 MMEs), with 1 in 4 patients receiving a refill. Conclusion: Opioids are being overprescribed for arthroscopic procedures of the shoulder, knee, and hip, with more than one-third of prescribed opioids remaining postoperatively. The majority of patients are unaware of the appropriate disposal techniques for surplus opioids. Appropriate risk stratification tools and evidence-based recommendations regarding pain management strategies after arthroscopic procedures are needed to help curb the growing opioid crisis.

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Section: Discussionmentioning

confidence: 99%

Opioid Use After Common Sports Medicine Procedures: A Systematic Review

et al. 2020

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“…Due to the growing problem of opioid abuse, Prentice et al [20] conducted a cohort study to investigate the preoperative risk factors leading to opioid use after total hip arthroplasty, the result showed that the risk factors led to greater utilization in days 91 to 360 including higher body mass index, female sex, acquired immunode ciency syndrome and peripheral vascular disease. Wagner et al [21] found that the use of liposomal bupivacaine during THA reduced postoperative opioid use as well as the length of hospital stay. A prospective randomized controlled trial conducted by Lucero [22] showed that additional dose of dexamethasone after surgery could signi cantly relieve pain and reduce tramadol consumption for patients undergoing primary THA.…”

Section: Discussionmentioning

confidence: 99%

Topical use of tranexamic acid can reduce opioid consumption for patients undergoing primary total hip arthroplasty: a prospective randomized controlled trial

Shen

Jiang

Wang

et al. 2023

Preprint

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Background: The problem of opioid addiction after total hip arthroplasty (THA) has been widely concerned. Tranexamic acid (TXA) has been shown to be effective in reducing blood loss for patients undergoing THA, but few studies focus on its alleviation of postoperative local pain symptoms. The purpose of this study was to investigate whether topical TXA could reduce early postoperative hip pain for primary THA patients, thereby reducing the use of opioids, and whether local pain is related to inflammatory response. Methods: In this prospective randomized controlled study, we randomly divided 161patients into a topical group (n=79) and an intravenous group (n=82). Hip pain was assessed using the visual analogue scale (VAS) score within three days after surgery and tramadol was used for pain relief when necessary. Inflammatory markers such as high-sensitivity C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), interleukin-6 (IL-6), total blood loss and hemoglobin drop were assessed by hematologic tests. The primary outcomes included the VAS score and dose of tramadol from the first to the third day after surgery. The secondary outcomes included the inflammatory markers level, total blood loss and complications. Results: The pain score and inflammation markers level on the first day in the topical TXA group were significantly lower than those in the intravenous TXA group (P＜0.05). The correlation analysis showed that the VAS score on the first day after surgery was positively correlated with the inflammation markers level (P＜0.05). The tramadol dose for topical group was lower than intravenous group on the first and second day after surgery. There were no differencesin total blood loss between the two groups (640.60± 188.12ml vs. 634.20± 187.85ml, P= 0.06). There was no difference in the incidence of complications. Conclusion: Topical use of TXA could relieve the local pain symptoms and reduce opioid consumption for patients undergoing primary THA by reduce the early postoperative inflammatory response. Trial registration: The trial was registered at the China Clinical Trial Registry (ChiCTR2100052396) on 10/24/2021.

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“…Due to the growing problem of opioid abuse, Prentice et al [ 20 ] conducted a cohort study to investigate the preoperative risk factors leading to opioid use after total hip arthroplasty, the result showed that the risk factors led to greater utilization in days 91 to 360 including higher body mass index, female sex, acquired immunodeficiency syndrome and peripheral vascular disease. Wagner et al [ 21 ] found that the use of liposomal bupivacaine during THA reduced postoperative opioid use as well as the length of hospital stay. A prospective randomized controlled trial conducted by Lucero [ 22 ] showed that additional dose of dexamethasone after surgery could significantly relieve pain and reduce tramadol consumption for patients undergoing primary THA.…”

Section: Discussionmentioning

confidence: 99%

Topical use of tranexamic acid can reduce opioid consumption compared with intravenous use for patients undergoing primary total hip arthroplasty: a prospective randomized controlled trial

Shen

Jiang

Wang

et al. 2023

BMC Musculoskelet Disord

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Background The problem of opioid addiction after total hip arthroplasty (THA) has been widely concerned. Tranexamic acid (TXA) has been shown to be effective in reducing blood loss for patients undergoing THA, but few studies focus on its alleviation of postoperative local pain symptoms. The purpose of this study was to investigate whether topical TXA could reduce early postoperative hip pain for primary THA patients, thereby reducing the use of opioids, and whether local pain is related to inflammatory response. Methods In this prospective randomized controlled study, we randomly divided 161 patients into a topical group (n = 79) and an intravenous group (n = 82). Hip pain was assessed using the visual analogue scale (VAS) score within three days after surgery and tramadol was used for pain relief when necessary. Inflammatory markers such as high-sensitivity C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), interleukin-6 (IL-6), total blood loss and hemoglobin drop were assessed by hematologic tests. The primary outcomes included the VAS score and dose of tramadol from the first to the third day after surgery. The secondary outcomes included the inflammatory markers level, total blood loss and complications. Results The pain score and inflammation markers level on the first day in the topical TXA group were significantly lower than those in the intravenous TXA group (P < 0.05). The correlation analysis showed that the VAS score on the first day after surgery was positively correlated with the inflammation markers level (P < 0.05). The tramadol dose for topical group was lower than intravenous group on the first and second day after surgery. There were no differences in total blood loss between the two groups (640.60 ± 188.12 ml vs. 634.20 ± 187.85 ml, P = 0.06). There was no difference in the incidence of complications. Conclusion Topical use of TXA could relieve the local pain symptoms and reduce opioid consumption compared with intravenous use for patients undergoing primary THA by reduce the early postoperative inflammatory response. Trial registration The trial was registered at the China Clinical Trial Registry (ChiCTR2100052396) on 10/24/2021.

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Liposomal bupivacaine reduces opioid consumption and length of stay in patients undergoing primary total hip arthroplasty

Abstract: Substituting to LB from a standard wound infiltrate during primary THA, in addition to our standard multimodal pain management protocol, resulted in significantly lower postoperative opioid consumption and decreased length of stay.

Cited by 9 publications

References 11 publications

Opioid Use After Common Sports Medicine Procedures: A Systematic Review

Opioid Use After Common Sports Medicine Procedures: A Systematic Review

Topical use of tranexamic acid can reduce opioid consumption for patients undergoing primary total hip arthroplasty: a prospective randomized controlled trial

Topical use of tranexamic acid can reduce opioid consumption compared with intravenous use for patients undergoing primary total hip arthroplasty: a prospective randomized controlled trial

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