A Meta-Analysis Comparing Liposomal Bupivacaine and Traditional Periarticular Injection for Pain Control after Total Knee Arthroplasty

Abstract

Liposomal bupivacaine is a novel method for pain control after total knee arthroplasty (TKA), but recent studies showed no advantage for patients undergoing TKA compared with traditional periarticular injection (PAI). The purpose of this analysis was to compare the clinical outcomes between liposomal bupivacaine treatment and traditional PAI. We retrospectively reviewed data from 16 clinical trials in published databases from their inception to June 2017. The primary outcome was postoperative Visual Analogue Scale (VAS) score and secondary outcomes included opiate usage, narcotic consumption, range of motion, and length of stay. Nine randomized controlled trials and seven nonrandomized controlled trials involving 924 liposomal bupivacaine cases and 1,293 traditional PAI cases were eligible for inclusion in the meta-analysis. No differences were detected in most of the clinical outcomes, except for postoperative VAS within 12 hours and length of stay. This analysis showed that liposomal bupivacaine is not associated with significant improvement in postoperative pain control or other outcomes in TKA compared with PAI.

Keywords

liposomal bupivacaine - periarticular injection - total knee arthroplasty - meta-analysis

• References

• 1 Kurtz SM, Ong KL, Lau E. , et al. International survey of primary and revision total knee replacement. Int Orthop 2011; 35 (12) 1783-1789
• 2 Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet 2006; 367 (9522): 1618-1625
• 3 Kessler ER, Shah M, Gruschkus SK, Raju A. Cost and quality implications of opioid-based postsurgical pain control using administrative claims data from a large health system: opioid-related adverse events and their impact on clinical and economic outcomes. Pharmacotherapy 2013; 33 (04) 383-391
• 4 Kelley TC, Adams MJ, Mulliken BD, Dalury DF. Efficacy of multimodal perioperative analgesia protocol with periarticular medication injection in total knee arthroplasty: a randomized, double-blinded study. J Arthroplasty 2013; 28 (08) 1274-1277
• 5 Lamplot JD, Wagner ER, Manning DW. Multimodal pain management in total knee arthroplasty: a prospective randomized controlled trial. J Arthroplasty 2014; 29 (02) 329-334
• 6 Jiang J, Teng Y, Fan Z, Khan MS, Cui Z, Xia Y. The efficacy of periarticular multimodal drug injection for postoperative pain management in total knee or hip arthroplasty. J Arthroplasty 2013; 28 (10) 1882-1887
• 7 Bramlett K, Onel E, Viscusi ER, Jones K. A randomized, double-blind, dose-ranging study comparing wound infiltration of DepoFoam bupivacaine, an extended-release liposomal bupivacaine, to bupivacaine HCl for postsurgical analgesia in total knee arthroplasty. Knee 2012; 19 (05) 530-536
• 8 Bagsby DT, Ireland PH, Meneghini RM. Liposomal bupivacaine versus traditional periarticular injection for pain control after total knee arthroplasty. J Arthroplasty 2014; 29 (08) 1687-1690
• 9 Schroer WC, Diesfeld PG, LeMarr AR, Morton DJ, Reedy ME. Does extended-release liposomal bupivacaine better control pain than bupivacaine after total knee arthroplasty (TKA)? A prospective, randomized clinical trial. J Arthroplasty 2015; 30 (9, Suppl): 64-67
• 10 Kenes MT, Leonard MC, Bauer SR, Wyman MJ. Liposomal bupivacaine versus continuous infusion bupivacaine via an elastomeric pump for the treatment of postoperative pain. Am J Health Syst Pharm 2015; 72 (23) (Suppl. 03) S127-S132
• 11 White S, Vaughan C, Raiff D, Eward W, Bolognesi M. Impact of liposomal bupivacaine administration on postoperative pain in patients undergoing total knee replacement. Pharmacotherapy 2015; 35 (05) 477-481
• 12 Kirkness CS, Asche CV, Ren J, Kim M, Rainville EC. Cost-benefit evaluation of liposomal bupivacaine in the management of patients undergoing total knee arthroplasty. Am J Health Syst Pharm 2016; 73 (09) e247-e254
• 13 Meneghini RM, Bagsby D, Ireland PH. , et al. Liposomal bupivacaine injection technique in total knee arthroplasty. J Knee Surg 2017; 30 (01) 88-96
• 14 Wang Y, Klein MS, Mathis S, Fahim G. Adductor canal block with bupivacaine liposome versus ropivacaine pain ball for pain control in total knee arthroplasty: a retrospective cohort study. Ann Pharmacother 2016; 50 (03) 194-202
• 15 Barrington JW, Emerson RH, Lovald ST, Lombardi AV, Berend KR. No difference in early analgesia between liposomal bupivacaine injection and intrathecal morphine after TKA. Clin Orthop Relat Res 2017; 475 (01) 94-105
• 16 Klug MJ, Rivey MP, Carter JT. Comparison of intraoperative periarticular injections versus liposomal bupivacaine as part of a multimodal approach to pain management in total knee arthroplasty. Hosp Pharm 2016; 51 (04) 305-311
• 17 Collis PN, Hunter AM, Vaughn MD, Carreon LY, Huang J, Malkani AL. Periarticular injection after total knee arthroplasty using liposomal bupivacaine vs a modified Ranawat suspension: a prospective, randomized study. J Arthroplasty 2016; 31 (03) 633-636
• 18 Jain RK, Porat MD, Klingenstein GG, Reid JJ, Post RE, Schoifet SD. Liposomal bupivacaine and periarticular injection are not superior to single-shot intra-articular injection for pain control in total knee arthroplasty. J Arthroplasty 2016; 31 (9, Suppl): 22-25
• 19 Snyder MA, Scheuerman CM, Gregg JL, Ruhnke CJ, Eten K. Improving total knee arthroplasty perioperative pain management using a periarticular injection with bupivacaine liposomal suspension. Arthroplast Today 2016; 2 (01) 37-42
• 20 Schwarzkopf R, Drexler M, Ma MW. , et al. Is there a benefit for liposomal bupivacaine compared to a traditional periarticular injection in total knee arthroplasty patients with a history of chronic opioid use?. J Arthroplasty 2016; 31 (08) 1702-1705
• 21 Alijanipour P, Tan TL, Matthews CN. , et al. Periarticular injection of liposomal bupivacaine offers no benefit over standard bupivacaine in total knee arthroplasty: a prospective, randomized, controlled trial. J Arthroplasty 2017; 32 (02) 628-634
• 22 DeClaire JH, Aiello PM, Warritay OK, Freeman DC. Effectiveness of bupivacaine liposome injectable suspension for postoperative pain control in total knee arthroplasty: a prospective, randomized, double blind, controlled study. J Arthroplasty 2017; 32 (9S): S268-S271
• 23 Grant GJ, Barenholz Y, Bolotin EM. , et al. A novel liposomal bupivacaine formulation to produce ultralong-acting analgesia. Anesthesiology 2005; 49 (01) 45-46
• 24 Chahar P, Cummings III KC. Liposomal bupivacaine: a review of a new bupivacaine formulation. J Pain Res 2012; 5 (05) 257-264
• 25 Okoroha KR, Keller RA, Marshall NE. , et al. Liposomal bupivacaine versus femoral nerve block for pain control after anterior cruciate ligament reconstruction: a prospective randomized trial. Arthroscopy 2016; 32 (09) 1838-1845
• 26 Surdam JW, Licini DJ, Baynes NT, Arce BR. The use of exparel (liposomal bupivacaine) to manage postoperative pain in unilateral total knee arthroplasty patients. J Arthroplasty 2015; 30 (02) 325-329
• 27 Kessler ER, Pierce DP, Whalen K. , et al. Response to “bupivacaine liposomal versus bupivacaine: comparative review.” Hosp Pharm 2014; 49 (09) 793-795
• 28 Kuang MJ, Du Y, Ma JX, He W, Fu L, Ma XL. The efficacy of liposomal bupivacaine using periarticular injection in total knee arthroplasty: a systematic review and meta-analysis. J Arthroplasty 2017; 32 (04) 1395-1402
• 29 Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003; 327 (7414): 557-560
• 30 Mashimo T, Uchida I, Pak M. , et al. Prolongation of canine epidural anesthesia by liposome encapsulation of lidocaine. Anesth Analg 1992; 74 (06) 827-834
• 31 Cherian JJ, Muzaffar A, Barrington JW. , et al. Liposomal bupivacaine in total knee arthroplasty for better postoperative analgesic outcome and economic benefits. J Knee Surg 2016; 29 (03) 180-187