Mounting evidence suggests that liposomal bupivacaine is the preferred analgesia for patients undergoing total hip replacement surgery.
The latest data come from a retrospective study, presented at the annual meeting of the American College of Clinical Pharmacy (poster 24), showing intraoperative, local site injections of liposomal bupivacaine (Exparel, Pacira) in patients undergoing a total hip arthroplasty (THA) decreased the hospital length of stay (LOS) by a half-day, improved physical function and reduced health care costs, compared with standard care.
“Centers that perform total hip replacements should strongly consider using liposomal bupivacaine,” said lead study author Ed Rainville, PharmMS, a supervisor in the Department of Pharmacy, OSF HealthCare Saint Francis Medical Center, in Peoria, Ill. “We have started using this for [all of our] total hip surgeries because of the benefit. A gain of even half a day for us is viewed as being significant and provides significant cost savings.”
Perioperative pain management for hip replacement patients is challenging. Suboptimal management can delay discharge, increase opioid use and decrease functional recovery, Mr. Rainville noted. Liposomal bupivacaine, an extended-release formulation of bupivacaine that is administered into the surgical site, is designed to allow drug diffusion to occur for up to 72 hours following a single administration.
The new study, by OSF HealthCare and the University of Illinois College of Medicine Center for Outcomes Research, also in Peoria, included 174 patients undergoing a THA at three hospitals. The investigational group received liposomal bupivacaine and the control group received standard of care treatment with usual bupivacaine or ropivacaine.
“There were no significant differences in pain scores on days 0, 1 and 2 or in postop opioid consumption,” Mr. Rainville added. “Post-discharge medical-related payments (30, 60, 90 days), discharge disposition and hospital readmissions also were similar in the two cohorts.”
Asked to comment on the study, Michelle Kohute, PharmD, a clinical pharmacy specialist in critical care at Jersey Shore University Medical Center, in Neptune, N.J., said although the study is limited due to its retrospective, unblinded nature, the reduction in hospital LOS and hospital costs without an increase in surgery-related readmissions was “certainly impressive.” The shorter LOS with liposomal bupivacaine, she said, has been shown in previous studies of THA. A recent meta-analysis of six studies found that liposomal bupivacaine is more effective than traditional bupivacaine in patients undergoing a THA, in terms of pain control at 24 hours and reduced hospital LOS (Medicine [Baltimore] 2017;96:e7190).
“Based on the pharmacokinetics of liposomal bupivacaine and results of prior published studies, I think that liposomal bupivacaine is an excellent alternative local anesthetic for THA,” Dr. Kohute said. “I would like to see the economic benefit of liposomal bupivacaine validated in a randomized, controlled clinical trial before recommending liposomal bupivacaine as the first-line agent for all THA.”