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J Knee Surg 2017; 30(01): 88-96
DOI: 10.1055/s-0036-1581133
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Liposomal Bupivacaine Injection Technique in Total Knee Arthroplasty

R. Michael Meneghini
1   Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
2   Department of Orthopedics and Sports Medicine, Indiana University Health Physicians, Fishers, Indiana
,
Deren Bagsby
1   Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
,
Philip H. Ireland
1   Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
2   Department of Orthopedics and Sports Medicine, Indiana University Health Physicians, Fishers, Indiana
,
Mary Ziemba-Davis
2   Department of Orthopedics and Sports Medicine, Indiana University Health Physicians, Fishers, Indiana
,
Luke R. Lovro
2   Department of Orthopedics and Sports Medicine, Indiana University Health Physicians, Fishers, Indiana
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Publikationsverlauf

25. Januar 2016

21. Februar 2016

Publikationsdatum:
27. April 2016 (online)

    Lizenzen und Reprints

Abstract

Liposomal bupivacaine has gained popularity for pain control after total knee arthroplasty (TKA), yet its true efficacy remains unproven. We compared the efficacy of two different periarticular injection (PAI) techniques for liposomal bupivacaine with a conventional PAI control group. This retrospective cohort study compared consecutive patients undergoing TKA with a manufacturer-recommended, optimized injection technique for liposomal bupivacaine, a traditional injection technique for liposomal bupivacaine, and a conventional PAI of ropivacaine, morphine, and epinephrine. The optimized technique utilized a smaller gauge needle and more injection sites. Self-reported pain scores, rescue opioids, and side effects were compared. There were 41 patients in the liposomal bupivacaine optimized injection group, 60 in the liposomal bupivacaine traditional injection group, and 184 in the conventional PAI control group. PAI liposomal bupivacaine delivered via manufacturer-recommended technique offered no benefit over PAI ropivacaine, morphine, and epinephrine. Mean pain scores and the proportions reporting no or mild pain, time to first opioid, and amount of opioids consumed were not better with PAI liposomal bupivacaine compared with PAI ropivacaine, morphine, and epinephrine. The use of the manufacturer-recommended technique for PAI of liposomal bupivacaine does not offer benefit over a conventional, less expensive PAI during TKA.

Keywords

liposomal bupivacaine - knee arthroplasty - periarticular injection - pain control - local analgesia
 

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