DISCONTINUED USE OF INTRAOPERATIVE LIPOSOMAL DELIVERY OF BUPIVACAINE IN PRIMARY TOTAL KNEE ARTHROPLASTY DID NOT ALTER PAIN SCORES, POSTOPERATIVE OPIOID CONSUMPTION, OR OBJECTIVE FUNCTIONAL STATUS

James E. Feng; Siddarth Mahure; Chibuokem Ikwuazom; James Slover; Ran Schwarzkopf; William J. Long; William B. Macaulay

doi:10.1302/1358-992X.2020.9.042

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DISCONTINUED USE OF INTRAOPERATIVE LIPOSOMAL DELIVERY OF BUPIVACAINE IN PRIMARY TOTAL KNEE ARTHROPLASTY DID NOT ALTER PAIN SCORES, POSTOPERATIVE OPIOID CONSUMPTION, OR OBJECTIVE FUNCTIONAL STATUS

The Knee Society (TKS) 2020 Members Meeting, held online, 10–12 September 2020.

James E. Feng
Siddarth Mahure
Chibuokem Ikwuazom
James Slover
Ran Schwarzkopf
William J. Long
William B. Macaulay

DISCONTINUED USE OF INTRAOPERATIVE LIPOSOMAL DELIVERY OF BUPIVACAINE IN PRIMARY TOTAL KNEE ARTHROPLASTY DID NOT ALTER PAIN SCORES, POSTOPERATIVE OPIOID CONSUMPTION, OR OBJECTIVE FUNCTIONAL STATUS

Feng JE, Mahure S, Ikwuazom C, et al. DISCONTINUED USE OF INTRAOPERATIVE LIPOSOMAL DELIVERY OF BUPIVACAINE IN PRIMARY TOTAL KNEE ARTHROPLASTY DID NOT ALTER PAIN SCORES, POSTOPERATIVE OPIOID CONSUMPTION, OR OBJECTIVE FUNCTIONAL STATUS. Orthop Procs. 2020;102-B(SUPP_9):42-42. doi:10.1302/1358-992X.2020.9.042

Feng, James E., et al. “DISCONTINUED USE OF INTRAOPERATIVE LIPOSOMAL DELIVERY OF BUPIVACAINE IN PRIMARY TOTAL KNEE ARTHROPLASTY DID NOT ALTER PAIN SCORES, POSTOPERATIVE OPIOID CONSUMPTION, OR OBJECTIVE FUNCTIONAL STATUS.” Orthopaedic Proceedings, vol. 102-B, no. SUPP_9, 2020, pp. 42-42., https://doi.org/10.1302/1358-992X.2020.9.042

Feng, J. E., Mahure, S., Ikwuazom, C., Slover, J., Schwarzkopf, R., Long, W. J., & Macaulay, W. B. (2020). DISCONTINUED USE OF INTRAOPERATIVE LIPOSOMAL DELIVERY OF BUPIVACAINE IN PRIMARY TOTAL KNEE ARTHROPLASTY DID NOT ALTER PAIN SCORES, POSTOPERATIVE OPIOID CONSUMPTION, OR OBJECTIVE FUNCTIONAL STATUS. Orthopaedic Proceedings, 102-B(SUPP_9), 42-42. https://doi.org/10.1302/1358-992X.2020.9.042

Feng, J. E., Mahure, S., Ikwuazom, C., Slover, J., Schwarzkopf, R., Long, W. J. et al. (2020) “DISCONTINUED USE OF INTRAOPERATIVE LIPOSOMAL DELIVERY OF BUPIVACAINE IN PRIMARY TOTAL KNEE ARTHROPLASTY DID NOT ALTER PAIN SCORES, POSTOPERATIVE OPIOID CONSUMPTION, OR OBJECTIVE FUNCTIONAL STATUS.” Orthopaedic Proceedings, 102-B(SUPP_9), pp. 42-42. Available at: https://doi.org/10.1302/1358-992X.2020.9.042

Feng, James E., Siddarth Mahure, Chibuokem Ikwuazom, James Slover, Ran Schwarzkopf, William J. Long, and William B. Macaulay. “DISCONTINUED USE OF INTRAOPERATIVE LIPOSOMAL DELIVERY OF BUPIVACAINE IN PRIMARY TOTAL KNEE ARTHROPLASTY DID NOT ALTER PAIN SCORES, POSTOPERATIVE OPIOID CONSUMPTION, OR OBJECTIVE FUNCTIONAL STATUS.” Orthopaedic Proceedings 102-B, no. SUPP_9 (2020): 42-42. https://doi.org/10.1302/1358-992X.2020.9.042

Feng JE, Mahure S, Ikwuazom C, Slover J, Schwarzkopf R, Long WJ, et al. DISCONTINUED USE OF INTRAOPERATIVE LIPOSOMAL DELIVERY OF BUPIVACAINE IN PRIMARY TOTAL KNEE ARTHROPLASTY DID NOT ALTER PAIN SCORES, POSTOPERATIVE OPIOID CONSUMPTION, OR OBJECTIVE FUNCTIONAL STATUS. Orthop Procs. 2020 Oct 1;102-B(SUPP_9):42-42. https://doi.org/10.1302/1358-992X.2020.9.042

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Abstract

Introduction

The use of intraoperative liposomal bupivacaine (LB) peri-articular injection has been highly debated for total knee arthroplasty (TKA). We evaluated the effect of an institutional-wide discontinuation of intraoperative LB on immediate postoperative pain scores, opioid consumption, and objective functional outcomes.

Material and Methods

Between July 1, 2019 and November 30, 2019, an institutional policy discontinued use of intraoperative LB, while the volume of non-LB with epinephrine was increased from 40-ml to 60-ml. A historical cohort was derived from patients undergoing TKA between January 1, 2019 and June 30, 2019. All patients received the same opioid sparing protocol, minimizing variability in prescribing habits. No adductor canal blocks/pumps were utilized.

Nursing documented verbal rating scale (VRS) pain scores were collected from our electronic data warehouse and averaged per patient per 12-hour interval. Opiate administration events were derived as Morphine Milligram Equivalences (MMEs) per patient per 24-hour interval. To assess immediate postoperative functional status, the validated Activity Measure for Post-Acute Care (AM-PAC) tool was utilized. All time events were calculated relative to TKA completion instant.

Results

789 primary TKAs did not receive intraoperative LB, while 888 patients acted as controls. Age was significantly greater in patients that did not receive intraoperative liposomal bupivacaine (66.80±8.97 vs 65.57±9.46; p<.01). Gender, BMI, ASA physical status score, race, smoking status, marital status, surgical time, length of stay and discharge disposition were similar between the two groups (p>.05).

Compared to historical controls, discontinuation of LB demonstrated no significant difference in postoperative inpatient VRS pain scores up to 72 hours (p>.05), opioid administration up to 96 hours (p>.05), or AM-PAC scores within the first 24 hours (p>.05).

Discussion

Subjective pain scores, opioid consumption, and functional scores were unchanged in the early postoperative period following the discontinuation of intraoperative liposomal delivery of bupivacaine in TKA.