Download PDF
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
› Author Affiliations
Further Information

Publication History

25 January 2016

21 February 2016

Publication Date:
27 April 2016 (online)

    Permissions and 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
 

  • References

  • 1 Parvizi J, Miller AG, Gandhi K. Multimodal pain management after total joint arthroplasty. J Bone Joint Surg Am 2011; 93 (11) 1075-1084
    CrossrefPubMedGoogle Scholar
  • 2 Grosu I, Lavand'homme P, Thienpont E. Pain after knee arthroplasty: an unresolved issue. Knee Surg Sports Traumatol Arthrosc 2014; 22 (8) 1744-1758
    CrossrefPubMedGoogle Scholar
  • 3 Kalkman CJ, Visser K, Moen J, Bonsel GJ, Grobbee DE, Moons KG. Preoperative prediction of severe postoperative pain. Pain 2003; 105 (3) 415-423
    CrossrefPubMedGoogle Scholar
  • 4 Liu SS, Buvanendran A, Rathmell JP , et al. Predictors for moderate to severe acute postoperative pain after total hip and knee replacement. Int Orthop 2012; 36 (11) 2261-2267
    Google Scholar
  • 5 Rakel BA, Blodgett NP, Bridget Zimmerman M , et al. Predictors of postoperative movement and resting pain following total knee replacement. Pain 2012; 153 (11) 2192-2203
    CrossrefPubMedGoogle Scholar
  • 6 Barrington JW, Halaszynski TM, Sinatra RS ; Expert Working Group on Anesthesia and Orthopaedics Critical Issues in Hip and Knee Replacement Arthroplasty FT. Perioperative pain management in hip and knee replacement surgery. Am J Orthop 2014; 43 (4, Suppl) S1-S16
    PubMedGoogle Scholar
  • 7 Affas F, Nygårds EB, Stiller CO, Wretenberg P, Olofsson C. Pain control after total knee arthroplasty: a randomized trial comparing local infiltration anesthesia and continuous femoral block. Acta Orthop 2011; 82 (4) 441-447
    CrossrefPubMedGoogle Scholar
  • 8 Busch CA, Shore BJ, Bhandari R , et al. Efficacy of periarticular multimodal drug injection in total knee arthroplasty. A randomized trial. J Bone Joint Surg Am 2006; 88 (5) 959-963
    CrossrefPubMedGoogle Scholar
  • 9 Chang CB, Cho WS. Pain management protocols, peri-operative pain and patient satisfaction after total knee replacement: a multicentre study. J Bone Joint Surg Br 2012; 94 (11) 1511-1516
    CrossrefPubMedGoogle Scholar
  • 10 Essving P, Axelsson K, Kjellberg J, Wallgren O, Gupta A, Lundin A. Reduced morphine consumption and pain intensity with local infiltration analgesia (LIA) following total knee arthroplasty. Acta Orthop 2010; 81 (3) 354-360
    CrossrefPubMedGoogle Scholar
  • 11 Kerr DR, Kohan L. Local infiltration analgesia: a technique for the control of acute postoperative pain following knee and hip surgery: a case study of 325 patients. Acta Orthop 2008; 79 (2) 174-183
    CrossrefPubMedGoogle Scholar
  • 12 Thorsell M, Holst P, Hyldahl HC, Weidenhielm L. Pain control after total knee arthroplasty: a prospective study comparing local infiltration anesthesia and epidural anesthesia. Orthopedics 2010; 33 (2) 75-80
    CrossrefPubMedGoogle Scholar
  • 13 Banerjee P, Rogers BA. Systematic review of high-volume multimodal wound infiltration in total knee arthroplasty. Orthopedics 2014; 37 (6) 403-412
    CrossrefPubMedGoogle Scholar
  • 14 Marques EM, Jones HE, Elvers KT, Pyke M, Blom AW, Beswick AD. Local anaesthetic infiltration for peri-operative pain control in total hip and knee replacement: systematic review and meta-analyses of short- and long-term effectiveness. BMC Musculoskelet Disord 2014; 15 (1) 220
    CrossrefPubMedGoogle Scholar
  • 15 Chahar P, Cummings III KC. Liposomal bupivacaine: a review of a new bupivacaine formulation. J Pain Res 2012; 5: 257-264
    PubMedGoogle Scholar
  • 16 Broome B. Periarticular injection with liposomal bupivicaine, is technique the key?. J Arthroplasty 2014; 29 (11) 2233
    PubMedGoogle Scholar
  • 17 Bagsby DT, Ireland PH, Meneghini RM. Liposomal bupivacaine versus traditional periarticular injection for pain control after total knee arthroplasty. J Arthroplasty 2014; 29 (8) 1687-1690
    CrossrefPubMedGoogle Scholar
  • 18 Berend ME, Berend KR, Lombardi Jr AV. Advances in pain management: game changers in knee arthroplasty. Bone Joint J 2014; 96-B (11, Suppl A) 7-9
    CrossrefPubMedGoogle Scholar
  • 19 Cohen SM. Extended pain relief trial utilizing infiltration of Exparel(®), a long-acting multivesicular liposome formulation of bupivacaine: a Phase IV health economic trial in adult patients undergoing open colectomy. J Pain Res 2012; 5: 567-572
    PubMedGoogle Scholar
  • 20 Golf M, Daniels SE, Onel E. A phase 3, randomized, placebo-controlled trial of DepoFoam® bupivacaine (extended-release bupivacaine local analgesic) in bunionectomy. Adv Ther 2011; 28 (9) 776-788
    CrossrefPubMedGoogle Scholar
  • 21 Gorfine SR, Onel E, Patou G, Krivokapic ZV. Bupivacaine extended-release liposome injection for prolonged postsurgical analgesia in patients undergoing hemorrhoidectomy: a multicenter, randomized, double-blind, placebo-controlled trial. Dis Colon Rectum 2011; 54 (12) 1552-1559
    CrossrefPubMedGoogle Scholar
  • 22 Haas E, Onel E, Miller H, Ragupathi M, White PF. A double-blind, randomized, active-controlled study for post-hemorrhoidectomy pain management with liposome bupivacaine, a novel local analgesic formulation. Am Surg 2012; 78 (5) 574-581
    PubMedGoogle Scholar
  • 23 Smoot JD, Bergese SD, Onel E, Williams HT, Hedden W. The efficacy and safety of DepoFoam bupivacaine in patients undergoing bilateral, cosmetic, submuscular augmentation mammaplasty: a randomized, double-blind, active-control study. Aesthet Surg J 2012; 32 (1) 69-76
    CrossrefPubMedGoogle Scholar
  • 24 Bramlett K, Onel E, Viscusi ER, Jones K. A randomized, double-blind, dose-ranging study comparing wound infiltration of DepoFoam bupivacaine, an extended-release liposomal bupivacaine, to bupivacaine HCl for postsurgical analgesia in total knee arthroplasty. Knee 2012; 19 (5) 530-536
    CrossrefPubMedGoogle Scholar
  • 25 Broome CB, Burnikel B. Novel strategies to improve early outcomes following total knee arthroplasty: a case control study of intra articular injection versus femoral nerve block. Int Orthop 2014; 38 (10) 2087-2089
    CrossrefPubMedGoogle Scholar
  • 26 Surdam JW, Licini DJ, Baynes NT, Arce BR. The use of Exparel (liposomal bupivacaine) to manage postoperative pain in unilateral total knee arthroplasty patients. J Arthroplasty 2015; 30 (2) 325-329
    CrossrefPubMedGoogle Scholar
  • 27 Werner MU, Mjöbo HN, Nielsen PR, Rudin A. Prediction of postoperative pain: a systematic review of predictive experimental pain studies. Anesthesiology 2010; 112 (6) 1494-1502
    CrossrefPubMedGoogle Scholar
  • 28 Schroer W, Diesfeld P, LeMarr A, Morton DJ, Reedy M . Does extended-release liposomal bupivacaine better control postoperative knee pain than bupivacaine? Paper presented at American Association of Hip and Knee Surgeons 24th Annual Meeting; November 6–9, 2014; Dallas, TX.
    PubMed
  • 29 Chelly JE, Ben-David B, Williams BA, Kentor ML. Anesthesia and postoperative analgesia: outcomes following orthopedic surgery. Orthopedics 2003; 26 (8, Suppl) s865-s871
    CrossrefPubMedGoogle Scholar
  • 30 Horlocker TT, Kopp SL, Pagnano MW, Hebl JR. Analgesia for total hip and knee arthroplasty: a multimodal pathway featuring peripheral nerve block. J Am Acad Orthop Surg 2006; 14 (3) 126-135
    CrossrefPubMedGoogle Scholar
  • 31 Kroll MA, Otis JC, Sculco TP , et al. The relationship of stride characteristics to pain before and after total knee arthroplasty. Clin Orthop Relat Res 1989; (239) 191-195
    PubMedGoogle Scholar
  • 32 Mangano DT, Hollenberg M, Fegert G , et al; The Study of Perioperative Ischemia (SPI) Research Group. Perioperative myocardial ischemia in patients undergoing noncardiac surgery—I: Incidence and severity during the 4 day perioperative period. J Am Coll Cardiol 1991; 17 (4) 843-850
    CrossrefPubMedGoogle Scholar
  • 33 McGuire L, Heffner K, Glaser R , et al. Pain and wound healing in surgical patients. Ann Behav Med 2006; 31 (2) 165-172
    CrossrefPubMedGoogle Scholar
  • 34 Ryu J, Saito S, Yamamoto K, Sano S. Factors influencing the postoperative range of motion in total knee arthroplasty. Bull Hosp Jt Dis 1993; 53 (3) 35-40
    PubMedGoogle Scholar
  • 35 Sinatra RS, Torres J, Bustos AM. Pain management after major orthopaedic surgery: current strategies and new concepts. J Am Acad Orthop Surg 2002; 10 (2) 117-129
    PubMedGoogle Scholar
  • 36 Wang H, Boctor B, Verner J. The effect of single-injection femoral nerve block on rehabilitation and length of hospital stay after total knee replacement. Reg Anesth Pain Med 2002; 27 (2) 139-144
    PubMedGoogle Scholar
  • 37 Wells N, Pasero C, McCaffery M. Improving the quality of care through pain assessment and management. In: Hughes R, ed. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville, MD: Agency for Healthcare Research and Quality, U.S. Dept. of Health and Human Services; 2008
    Google Scholar
  • 38 Wisner DH. A stepwise logistic regression analysis of factors affecting morbidity and mortality after thoracic trauma: effect of epidural analgesia. J Trauma 1990; 30 (7) 799-804 , discussion 804–805
    CrossrefPubMedGoogle Scholar