Co-Authors: Taylor Burich; Michael Brandon Hardison; Jeremy Walley
Title: Optimizing Postoperative Pain Management in Total Hip Arthroplasty with Liposomal Bupivacaine
Background: Total hip arthroplasty (THA) is associated with significant postoperative pain, prolonged hospitalizations, early mobilization, and increased opioid utilization. In the United States, over 500,000 THA occur every year and can often lead to opioid over prescribing. Effective postoperative pain control is critical in THA to facilitate early mobilization, reduce opioid consumption, and support recovery. Liposomal bupivacaine is Food and Drug Administration (FDA) approved as a long-acting local and regional anesthetic. The purpose of this study is to assess liposomal bupivacaine utilization as a part of a multimodal analgesia approach to improve pain control and reduce opioid consumption following THA.
Methods: This study aims to evaluate the efficacy of liposomal bupivacaine as a part of a multimodal analgesic approach in patients undergoing THA. Data will be collected through patient interviews via a standardized questionnaire to determine opioid utilization, pain score, and time to regain mobility and sensation. Patients included in this study are those 18 years or older who underwent THA with liposomal bupivacaine utilization. Exclusion criteria will be patients receiving liposomal bupivacaine for any other indication and those with a documented hypersensitivity or allergic reaction to liposomal bupivacaine or any of its analogs. The primary objective of this study is to examine opioid requirements after surgery as well as pain scores in patients who received liposomal bupivacaine. Secondary objectives will include the time to regain mobility and sensation post-operatively, as well as cost savings from a reduction in length of stay.
Results: The primary endpoint saw the pain scores of those who received liposomal bupivacaine 17 individuals fell within mild pain scores (0-3), and 5 within the moderate pain scores (4-6). Compared to the standard of care group who had 13,16,13 in their mild, moderate, and severe pain scores. As for opioid requirements there was change of an increase in usage within both groups, however, those who received liposomal bupivacaine required19 mg compared to standard of care which required on average 27.1 mg. As for secondary endpoints there was no difference within the mobility and sensation as both groups were moving about every hour at a minimum. Analysis for cost is still in progress.
Conclusion: Utilization of liposomal bupivacaine provides a multimodal approach for postoperative pain management in THA. Those individuals who received liposomal bupivacaine had a reduction in pain scores and opioid usage when compared to the standard of care.
