Liposomal bupivacaine did not reduce in-hospital opioid prescriptions or opioid-related complications in patients who received the drug during total knee replacement surgery, finds a study published Anesthesiology.
Previous studies suggested that the long-lasting pain control provided by liposomal bupivacaine could reduce the need for opioid painkillers, leading researchers to analyse how it would fare as part of a multimodal approach to managing postsurgical pain.
“When we tested this hypothesis in a real-world setting where state of the art pain procedures were used, we were unable to show benefit,” said Stavros G. Memtsoudis, MD, Hospital for Special Surgery, New York, New York. “Local anaesthesia has been proposed as being part of a multimodal approach to reducing opioid consumption, but we found that adding liposomal bupivacaine to the mix did not add significant benefit.”
While opioid-based regimens remain the cornerstone of postsurgical pain management, a multimodal approach involving a combination of opioids, non-opioid analgesics, and local anaesthetics is increasingly being used to provide pain relief, while reducing the need for postsurgical opioids and opioid-related adverse effects. However, the effectiveness of local anaesthetics is limited by a relatively short period of action. Physician anaesthesiologists had hoped liposomal bupivacaine, which is released slowly over time, would help solve this problem, said Dr. Memtsoudis.
The study looked at data from 88,830 total knee replacements performed between 2013 and 2016 with a peripheral nerve block as part of a multimodal regimen. One group had a peripheral nerve block and general anaesthesia, and another group had a peripheral nerve block and regional anaesthesia. Liposomal bupivacaine was used in conjunction with a peripheral nerve block in 21.2% (18,817) of patients. Between 2013 and 2016, the use of liposomal bupivacaine increased from 7% to 26%.
The researchers found the addition of liposomal bupivacaine was not associated with a decrease in patients’ risk for opioid-related complications including those affecting the respiratory, gastrointestinal, and central nervous system. Further, there was no clinically relevant decrease in inpatient opioid prescriptions or length of hospital stay and no reduction in cost of hospitalisation was seen.
The researchers noted that there is uncertainty in the data as to how liposomal bupivacaine was administered. It is expected that most was administrated by infiltration at the surgical site which is approved by the US Food and Drug Administration, but off-label use is possible in some cases.
“The routine use of liposomal bupivacaine should be carefully examined, especially given its relatively high cost,” concluded Dr. Memtsoudis. “We need to look for other ways to try to combat the opioid crisis, including trying to change physician and patient behaviour and expectations. We shouldn’t necessarily look at a pharmacological solution for everything.”