Study supports long-acting bupivacaine for postsurgical pain after joint replacement

Dr Emerson

Local infiltration with long-acting liposome bupivacaine (Exparel) as part of a non-narcotic multimodal pain management regimen for joint replacement surgeries, meaningfully improves patient and hospital economic outcomes, according to new data presented at the 81^st annual meeting of the American Academy of Orthopaedic Surgeons (AAOS).

Surgeons are exploring new approaches to pain management centered around liposome bupivacaine, which minimize drawbacks associated with more invasive anesthetic techniques, while providing pain control for 72 hours after surgery. The current standard of pain management is a continuous femoral nerve block, which, while providing effective pain control, can be associated with muscle weakness, limited mobility, and increased risk of accidental falls.

Roger Emerson, MD, orthopedic surgeon at Texas Center for Joint Replacement in Plano, Texas, was one of the investigators in a prospective, case-control study comparing outcomes in 1,000 total joint replacements (hips and knees) using long-acting liposome bupivacaine-based multimodal therapy to 1,000 previous cases which used standard pain management regimens (general, local, and regional anesthesia pre- and perioperatively, and non-steroidal anti-inflammatory drugs, acetaminophen and oral/IV narcotics for postoperative rescue). The primary outcome measure was patient-reported pain scores using a visual analog scale (VAS) and the secondary measures included length of stay, patient satisfaction, and cost. 

“The study showed that a multimodal pain management regimen centered on long-acting liposome bupivacaine provided better pain relief than a comparable regimen that did not include long-acting liposome bupivacaine,” according to Dr Emerson.  

In addition, the data showed that patients treated with the long-acting liposome bupivacaine regimen had a shorter length of stay, lower incidence of accidental falls, higher satisfaction ratings and an overall cost of care savings of $1,246.00 per case. 

“For managed care and hospital P&T decision-makers, this data shows that a postsurgical pain management regimen based on long-acting liposome bupivacaine can have a measurably positive impact on overall cost of care by shortening the length of hospital stay, and reducing or eliminating the need for supplies [catheters, pain pumps, etc.] and drugs [analgesics and anesthetics] required for a standard pain management protocol,” he said.  

More than 1 million patients have a hip or knee replaced each year in the United States.