DALLAS—Positive data about the use of Exparel (bupivacaine liposome injectable suspension) as a postsurgical analgesic following total knee replacement surgery was presented at the 25th Annual Meeting of the American Association of Hip and Knee Surgeons.
The study, which compared the use of bupivacaine liposome injectable suspension infiltration to the standard of care in 1,110 patients, found that bupivacaine liposome injectable suspension was associated with significant improvements in a variety of patient and health economic outcomes, including opioid use, hospital stay, and readmission rate.
Richard Iorio, MD
Patients who underwent total knee arthroplasty (TKA) received identical pre-, intra-, and postoperative pain management protocols, with the exception of 527 patients who received bupivacaine liposome injectable suspension infiltration in place of a femoral nerve block.
The study authors compared several patient and cost-related outcomes. Opioid use during hospitalization was statistically significantly reduced in the bupivacaine liposome injectable suspension group. Other key findings included:
• Shorter hospital length of stay (2.93 days for the bupivacaine liposome injectable suspension group vs 3.19 days for the femoral nerve block group, P<0.001)
• Increased rate of discharge to home (77.8% for the bupivacaine liposome injectable suspension group vs 72.21% for the femoral nerve block group, P=0.032)
• Reduced inpatient fall rate (0.56% for the bupivacaine liposome injectable suspension group vs 2.11% for the femoral nerve block group, P=0.03)
• Lower 30-day all-cause readmission rate (0.95% for the bupivacaine liposome injectable suspension group vs 2.57% for the femoral nerve block group, P=0.041)
“Based on our analysis, incorporating liposomal bupivacaine into the postsurgical analgesic protocol following total knee arthroplasty has significant and quantifiable benefits to both the patient and the institution,” said Richard Iorio, MD, Professor of Orthopaedic Surgery at NYU School of Medicine in New York. “The measurable opioid-sparing effect of this new regimen has enabled us to virtually eliminate intravenous patient-controlled analgesia, or PCA, devices from the standard of care in total joint arthroplasty patients, without compromising patient comfort. In addition, we found that the incremental cost of adding this new modality was offset by meaningful savings from shorter anesthesia induction time in the operating room, shorter hospital stays and lower rates of 30-day readmission.”