AAOS2017: Assessing liposomal bupivacaine in TKR

Study Type: Randomized Trial
OE Level of Evidence: N/A
Journal Level of Evidence: N/A
CONFERENCE ACE REPORTS
This ACE Report is a summary of a conference presentation or abstract. The information provided has limited the ability to provide an accurate assessment of the risk of bias or the overall quality. Please interpret the results with caution as trials may be in progress and select results may have been presented.
Synopsis
100 patients scheduled for total knee arthroplasty under spinal anesthesia were randomized to one of three groups: 1) liposomal bupivacaine for wound infiltration at the end of the procedure, 2) standard bupivacaine for wound infiltration at the end of the procedure and with the addition of a spinal narcotic, or 3) standard bupivacaine for wound infiltration at the end of the procedure without the addition of spinal narcotic. Results demonstrated no Please login to view the rest of this report. Please login to view the rest of this report.
Why was this study needed now?
Liposomal bupivacaine is a novel form of analgesic which has been proposed to provide extended pain relief compared to traditional bupivacaine. Interest in the use of liposomal bupivacaine for postoperative analgesia following total knee arthroplasty has increased; however, few studies have evaluated if this novel preparation provides significant benefit over traditional bupivacaine in this setting.
What was the principal research question?
In total knee arthroplasty, does wound infiltration with liposomal bupivacaine and spinal anesthesia without a narcotic result in any significant benefit regarding the length of stay, postoperative pain or function when compared to wound infiltration with standard bupivacaine and spinal anesthesia with and without a narcotic?
Population: 100 patients scheduled for total knee arthroplasty:
Intervention: Liposomal bupivacaine group: Patients underwent the procedure under spinal anesthesia without the addition of a narcotic and were administered wound infiltration using a solution containing liposomal bupivacaine. (n=29)
Comparison: Standard bupivacaine with spinal narcotic: Patients underwent the procedure under spinal anesthesia with the addition of a narcotic, and were administered wound infiltration using a solution containing standard bupivacaine (n=42). Standard bupivacaine without spinal narcotic: Patients underwent the procedure under spinal anesthesia without the addition of a narcotic, and were administered wound infiltration using a solution containing standard bupivacaine (n=24).
Outcomes: Reported outcome measures included: length of hospital stay, pain scores, narcotic consumption, and the incidence of adverse events, including nausea, vomiting, urticaria, confusion, urinary retention, ileus, deep vein thrombosis, and peroneal nerve palsy.
Methods: RCT
Time: Patients were followed up for 6 weeks.
What were the important findings?
CONTENT IS LOCKED
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.
Dr. Ian Weber
April 2, 2017
Orthopaedic Surgeon - United States
Technique???
April 4, 2017
Technique and volume are an issue if you don't use it correctly you will get the results such as this
Dr. Ortho Evidence
April 5, 2017
Other - Canada
Dear Dr. Weber, Thank you for your comment. Unfortunately, the conference abstract from which this ACE Report was created did not provide any additional information regarding the technique used.