Liposomal bupivacaine no better than HCl formulation in total joint arthroplasty

Treatment with liposome bupivacaine does not provide a significant benefit to patients with total joint arthroplasty relative to bupivacaine HCl formulation, reports a study.

“A new bupivacaine liposomal formulation was designed to extend its analgesic effect for up to 72-hours postsurgery, reportedly leading to significant opioid-sparing,” the authors said.

To test its efficacy, a retrospective and prospective chart review was conducted in a 178-bed academic institution between January 2013 to December 2013 and August 2014 to November 2014, including 115 patients that receive hip and knee arthroplasty.

Average daily pain score on postoperative days (POD) 1 and 2 was the primary outcome, while secondary ones included length of stay, overall opioid use postsurgery, and pain control satisfaction using Press-Ganey scores.

The average pain scores (Likert score: 0–10) in the HCl group were 4.64 for POD 1 and 4.38 for POD 2 compared to 4.72 for POD 1 and 4.2 for POD 2 in the liposome group (POD 1: p=0.413; POD 2: p=0.303).

A statistically significant difference was seen in length of stay for knee arthroplasty (HCl vs liposome group: 1.94±0.66 vs 2.27±0.77 days; p=0.038), favouring standard of care. For hip or bilateral knee arthroplasty, no statistically significant differences were noted in LOS (p=0.052 and p=0.484, respectively).

Pain was well-controlled in 93 percent of patients in the HCl group compared to 88.5 percent in the liposome group with similar oxycodone immediate release use among groups.

“Appropriate pain control is one of the cornerstones necessary to promote positive clinical outcomes,” the authors noted.