Potential Utility of Liposome Bupivacaine in Orthopedic Surgery
Management of postsurgical analgesia is an important consideration in orthopedic procedures, including joint arthroplasty. Inadequate postsurgical analgesia is associated with increased hospital length of stay, delayed ambulation, and reduced exercise capacity.
In this article, we review the potential contribution of a prolonged-release liposomal formulation of bupivacaine as part of a multimodal analgesic regimen after orthopedic surgery.
Controlled studies across multiple surgical settings have demonstrated that, compared with placebo and bupivacaine HCl, liposome bupivacaine in a single administration provides postsurgical analgesia for up to 72 hours, delays use of rescue medication, and reduces postsurgical opioid consumption. Liposome bupivacaine has been well tolerated in clinical studies and has had a low rate of treatment-related adverse events. To date, there has been no signal of cardiac toxicity, chondrolysis, or delayed wound healing associated with liposome bupivacaine.
Other ongoing investigator-sponsored studies in orthopedic populations include comparisons of liposome bupivacaine and bupivacaine HCl for ultrasound-guided periarticular hip infiltration in hip arthroplasty (NTC01917191),73 as femoral nerve block in TKA (NCT01977339),74 and as interscalene brachial plexus block in arthroscopic shoulder surgery (NCT01977352).75 The primary efficacy outcome measure in these studies was postsurgical opioid use.73-75
Health Economics
A series of phase 4 health economics studies was conducted for gastrointestinal surgeries, including open colectomy, laparoscopic colectomy, and ileostomy reversal.53-56,76 These studies, of similar design, showed that a liposome bupivacaine–based multimodal analgesic regimen was associated with reduced opioid use, shorter hospital LOS, and lower hospitalization costs in comparison with a traditional opioid-based regimen.53-56 Although pooled analysis of these studies showed a cost savings of more than $2000 per patient and an LOS decrease of 1.4 days,76 all were conducted in the gastrointestinal surgery setting. Studies are needed to fully assess the economic benefits associated with liposome bupivacaine in the orthopedic surgery setting.
Conclusion
Liposome bupivacaine represents a potentially important contributor to multimodal analgesic regimens used to manage postsurgical pain. Liposome bupivacaine has demonstrated efficacy in providing prolonged postsurgical analgesia and reducing postsurgical opioid use in most surgical settings studied. Additional data from health economics studies in gastrointestinal surgery suggest liposome bupivacaine–based multimodal analgesic regimens may also contribute to reductions in hospital LOS and hospitalization costs. Non-industry-sponsored trials are needed to answer these crucial questions in orthopedic surgery settings. Nevertheless, data on the safety and efficacy of liposome bupivacaine for postsurgical analgesia continue to accumulate, and liposome bupivacaine appears to be a feasible therapeutic option for managing postsurgical pain in orthopedic surgery.
