Clinical Review

Potential Utility of Liposome Bupivacaine in Orthopedic Surgery

Am J Orthop. 2015 March;44(3):111-117

References

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71. Femoral nerve block with liposome bupivacaine for postsurgical analgesia following total knee arthroplasty [NCT01683071]. ClinicalTrials.gov website. http://clinicaltrials.gov/ct2/show/NCT01683071?term=NCT01683071%5C&rank=1. Accessed January 30, 2015.

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74. Efficacy of single injection femoral nerve block with liposomal bupivacaine for total knee arthroplasty [NCT01977339]. ClinicalTrials.gov website. http://clinicaltrials.gov/ct2/show/NCT01977339?term=NCT01977339&rank=1. Accessed January 30, 2015.

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76. Cohen SM, Vogel JD, Marcet JE, Candiotti K. Liposome bupivacaine for improvement in economic outcomes and opioid burden in GI surgery: IMPROVE study pooled analysis. J Pain Res. 2014;7:359-366.

Other ongoing investigator-sponsored studies in orthopedic populations include comparisons of liposome bupivacaine and bupivacaine HCl for ultrasound-guided periarticular hip infiltration in hip arthroplasty (NTC01917191),⁷³ as femoral nerve block in TKA (NCT01977339),⁷⁴ and as interscalene brachial plexus block in arthroscopic shoulder surgery (NCT01977352).⁷⁵ The primary efficacy outcome measure in these studies was postsurgical opioid use.^73-75

Health Economics

A series of phase 4 health economics studies was conducted for gastrointestinal surgeries, including open colectomy, laparoscopic colectomy, and ileostomy reversal.^53-56,76 These studies, of similar design, showed that a liposome bupivacaine–based multimodal analgesic regimen was associated with reduced opioid use, shorter hospital LOS, and lower hospitalization costs in comparison with a traditional opioid-based regimen.^53-56 Although pooled analysis of these studies showed a cost savings of more than $2000 per patient and an LOS decrease of 1.4 days,⁷⁶ all were conducted in the gastrointestinal surgery setting. Studies are needed to fully assess the economic benefits associated with liposome bupivacaine in the orthopedic surgery setting.

Conclusion

Liposome bupivacaine represents a potentially important contributor to multimodal analgesic regimens used to manage postsurgical pain. Liposome bupivacaine has demonstrated efficacy in providing prolonged postsurgical analgesia and reducing postsurgical opioid use in most surgical settings studied. Additional data from health economics studies in gastrointestinal surgery suggest liposome bupivacaine–based multimodal analgesic regimens may also contribute to reductions in hospital LOS and hospitalization costs. Non-industry-sponsored trials are needed to answer these crucial questions in orthopedic surgery settings. Nevertheless, data on the safety and efficacy of liposome bupivacaine for postsurgical analgesia continue to accumulate, and liposome bupivacaine appears to be a feasible therapeutic option for managing postsurgical pain in orthopedic surgery.