Liposomal bupivacaine versus traditional bupivacaine for pain control after total hip arthroplasty

Ma, Tingting; Wang, Yuhui; Jiang, Yunfeng; Peng, Cong-bin; Chen, Yan; Zi-gui, Liu; Xu, Weixing

doi:10.1097/md.0000000000007190

Cited by 32 publications

(15 citation statements)

References 21 publications

(34 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our findings are similar to the results found by Domb et al, 8 which demonstrated significant decreases in opioid consumption and hospital LOS when patients received periarticular LB versus the control group who received plain bupivacaine. These findings are also consistent with a recent meta-analysis by Ma et al, 20 further demonstrating reductions in opioid consumption and hospital length of stay. Further randomised, controlled studies are needed to clarify the total difference in costs between patients who receive LB periarticular injections versus a non-LB cohort.…”

Section: Discussionsupporting

confidence: 92%

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

et al. 2018

View full text Add to dashboard Cite

show abstract

Section: Discussionsupporting

confidence: 92%

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

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Although this is a novel finding for the perineural route, it may not be totally new for liposomal bupivacaine. Several recent systematic reviews 27,30,[89][90][91][92][93][94][95][96][97] and an editorial 29 examining the evidence for surgeon-administered local infiltration analgesia using liposomal bupivacaine have questioned its effectiveness. Curiously, the underlying causes of both perineural and infiltration routes failing to provide incremental benefits when compared with nonliposomal bupivacaine, 98,99 and even placebo (normal saline), 12 may be similar.…”

Section: Discussionmentioning

confidence: 99%

Perineural Liposomal Bupivacaine Is Not Superior to Nonliposomal Bupivacaine for Peripheral Nerve Block Analgesia

et al. 2021

View full text Add to dashboard Cite

Background Liposomal bupivacaine is purported to extend analgesia of peripheral nerve blocks when administered perineurally. However, evidence of the clinical effectiveness of perineural liposomal bupivacaine is mixed. This meta-analysis seeks to evaluate the effectiveness of perineural liposomal bupivacaine in improving peripheral nerve block analgesia as compared with nonliposomal local anesthetics. Methods The authors identified randomized trials evaluating the effectiveness of peripheral nerve block analgesic that compared liposomal bupivacaine with nonliposomal local anesthetics. The primary outcome was the difference in area under the receiver operating characteristics curve (AUC) of the pooled 24- to 72-h rest pain severity scores. Secondary outcomes included postoperative analgesic consumption, time to first analgesic request, incidence of opioid-related side effects, patient satisfaction, length of hospital stay, liposomal bupivacaine side effects, and functional recovery. AUC pain scores were interpreted in light of a minimal clinically important difference of 2.0 cm · h. Results Nine trials (619 patients) were analyzed. When all trials were pooled, AUC pain scores ± SD at 24 to 72 h were 7.6 ± 4.9 cm · h and 6.6 ± 4.6 cm · h for nonliposomal and liposomal bupivacaine, respectively. As such, perineural liposomal bupivacaine provided a clinically unimportant benefit by improving the AUC (95% CI) of 24- to 72-h pain scores by 1.0 cm · h (0.5 to 1.6; P = 0.003) compared with nonliposomal bupivacaine. Excluding an industry-sponsored trial rendered the difference between the groups nonsignificant (0.7 cm · h [−0.1 to 1.5]; P = 0.100). Secondary outcome analysis did not uncover any additional benefits to liposomal bupivacaine in pain severity at individual timepoints up to 72 h, analgesic consumption, time to first analgesic request, opioid-related side effects, patient satisfaction, length of hospital stay, and functional recovery. No liposomal bupivacaine side effects were reported. Conclusions Perineural liposomal bupivacaine provided a statistically significant but clinically unimportant improvement in the AUC of postoperative pain scores compared with plain local anesthetic. Furthermore, this benefit was rendered nonsignificant after excluding an industry-sponsored trial, and liposomal bupivacaine was found to be not different from plain local anesthetics for postoperative pain and all other analgesic and functional outcomes. High-quality evidence does not support the use of perineural liposomal bupivacaine over nonliposomal bupivacaine for peripheral nerve blocks. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

show abstract

“…THA Two MAs compare LB to plain bupivacaine-PAI for THA [62,111]. In both, LB significantly reduces pain scores and opioid consumption up to 48 h after THA.…”

Section: Continuous-release Local Anestheticsmentioning

confidence: 99%

Regional and Multimodal Analgesia to Reduce Opioid Use after Total Joint Arthroplasty: A Narrative Review

Soffin

2019

HSS Journal®

View full text Add to dashboard Cite

Background Elective total joint arthroplasty may be a gateway to long-term opioid use. Questions/Purpose We sought to review the literature on multimodal and regional analgesia as a strategy to minimize perioperative opioid use and control pain in patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA). Methods We conducted a narrative review to assess the state of the evidence informing opioid-sparing analgesics for THA and TKA. A PubMed search was conducted for English-language articles published before April 2018. We preferentially included well-designed randomized controlled trials, systematic reviews, and meta-analyses. Where the highest levels of evidence were not yet apparent, we evaluated retrospective and/or observational studies. Results Multimodal analgesia emphasizing nonsteroidal anti-inflammatory agents and acetaminophen is associated with decreases in perioperative opioid use for THA and TKA. Regional analgesia, including peripheral nerve blocks and local infiltration analgesia, is also associated with decreased perioperative opioid use for THA and TKA. Emerging topics in post-arthroplasty analgesia include (1) the value of nonsteroidal anti-inflammatory drugs, (2) the use of peripheral nerve catheters and extended-release local anesthetics to prolong the duration of opioid-free analgesia, and (3) novel peripheral nerve blocks, exemplified by the IPACK (interspace between the popliteal artery and posterior capsule of the knee) block for TKA. Conclusions The use of multimodal analgesia with regional techniques may decrease perioperative opioid use for patients undergoing THA and TKA. These techniques should be part of a comprehensive perioperative plan to promote adequate analgesia while minimizing overall opioid exposure.

show abstract

Liposomal bupivacaine versus traditional bupivacaine for pain control after total hip arthroplasty

Cited by 32 publications

References 21 publications

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

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

Perineural Liposomal Bupivacaine Is Not Superior to Nonliposomal Bupivacaine for Peripheral Nerve Block Analgesia

Regional and Multimodal Analgesia to Reduce Opioid Use after Total Joint Arthroplasty: A Narrative Review

Contact Info

Product

Resources

About