Risk factors for liposomal bupivacaine resistance after total hip or knee arthroplasties: a retrospective observational cohort in 237 patients

doi:10.1186/s13037-020-0230-4

. 2020 Jan 30:14:6.

doi: 10.1186/s13037-020-0230-4. eCollection 2020.

Risk factors for liposomal bupivacaine resistance after total hip or knee arthroplasties: a retrospective observational cohort in 237 patients

Scott Buzin¹, Arianna L Gianakos¹, Deborah Li², Anthony Viola³, Sherif Elkattawy¹, David M Keller¹, Richard S Yoon¹, Frank A Liporace¹

Affiliations

¹ 1Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJBarnabas Health, 377 Jersey Ave, Suite 280A, Jersey City, NJ 07302 USA.
² 2University of Miami Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL 33136 USA.
³ 3Philadelphia College of Osteopathic Medicine, 4190 City Ave, Suite 409, Philadelphia, PA 19131 USA.

PMID: 32015758
PMCID: PMC6990520
DOI: 10.1186/s13037-020-0230-4

Risk factors for liposomal bupivacaine resistance after total hip or knee arthroplasties: a retrospective observational cohort in 237 patients

Scott Buzin et al. Patient Saf Surg. 2020.

. 2020 Jan 30:14:6.

doi: 10.1186/s13037-020-0230-4. eCollection 2020.

Authors

Scott Buzin¹, Arianna L Gianakos¹, Deborah Li², Anthony Viola³, Sherif Elkattawy¹, David M Keller¹, Richard S Yoon¹, Frank A Liporace¹

Affiliations

¹ 1Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJBarnabas Health, 377 Jersey Ave, Suite 280A, Jersey City, NJ 07302 USA.
² 2University of Miami Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL 33136 USA.
³ 3Philadelphia College of Osteopathic Medicine, 4190 City Ave, Suite 409, Philadelphia, PA 19131 USA.

PMID: 32015758
PMCID: PMC6990520
DOI: 10.1186/s13037-020-0230-4

Abstract

Purpose: Liposomal bupivacaine demonstrated promise decreasing postoperative pain in total hip and total knee arthroplasty (THA/TKA). Some randomized trials have shown non-superior results; however, confounding variables were not accounted for in such analyses. This study attempts to determine risk factors associated with failure of pain management in patients receiving liposomal bupivacaine.

Methods: Postoperative pain scores were collected following primary or revision arthroplasties between January 2016 and December 2017. Retrospective analysis of institutional total joint quality and outcomes registry was screened and patients undergoing primary or revision arthroplasties who completed a multi-modal pain management including liposomal bupivacaine were included in the study. Patients with a history of infection/deviated from the institutional pain management protocol were excluded.

Results: A total of 237 patients were included for analysis. Younger patients less than 64 years old had significantly higher pain scores between 0 and 12 h and > 24 h. Active smokers had significantly higher pain scores between 0 and 6 h and > 24 h. Patients with a history of opioid use/pain management had significantly higher pain scores at 6-12 h and 24-48 h. Regression analysis indicated risk factors for resistance to liposomal bupivacaine are younger patients less than 64 years old, those undergoing primary THA, and patients with a history of smoking/pain management/opioid use.

Conclusion: We identify risk factors for resistance to liposomal bupivacaine, which include younger age less than 64 years old, history of smoking/pain management/opioid use. Future studies should use these risk factors as exclusion criteria when using liposomal bupivacaine or initiating any randomized trials regarding efficacy.

Keywords: Liposomal bupivacaine; Pain management; Total hip arthroplasty; Total knee arthroplasty.

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Conflict of interest statement

Competing interestsThe authors declare that they have no competing interests.

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[1] Rutherford RW, Jennings JM, Dennis DA. Enhancing recovery after Total knee Arthroplasty. Orthop Clin North Am. 2017;48(4):391–400. doi: 10.1016/j.ocl.2017.05.002. - DOI - PubMed

[2] Rutherford RW, Jennings JM, Dennis DA. Enhancing recovery after Total knee Arthroplasty. Orthop Clin North Am. 2017;48(4):391–400. doi: 10.1016/j.ocl.2017.05.002. - DOI - PubMed

[3] Lamplot JD, Wagner ER, Manning DW. Multimodal pain management in total knee arthroplasty: a prospective randomized controlled trial. J Arthroplast. 2014;29(2):329–334. doi: 10.1016/j.arth.2013.06.005. - DOI - PubMed

[4] Lamplot JD, Wagner ER, Manning DW. Multimodal pain management in total knee arthroplasty: a prospective randomized controlled trial. J Arthroplast. 2014;29(2):329–334. doi: 10.1016/j.arth.2013.06.005. - DOI - PubMed

[5] Maheshwari AV, Blum YC, Shekhar L, Ranawat AS, Ranawat CS. Multimodal pain management after total hip and knee arthroplasty at the Ranawat Orthopaedic center. Clin Orthop Relat Res. 2009;467(6):1418–1423. doi: 10.1007/s11999-009-0728-7. - DOI - PMC - PubMed

[6] Maheshwari AV, Blum YC, Shekhar L, Ranawat AS, Ranawat CS. Multimodal pain management after total hip and knee arthroplasty at the Ranawat Orthopaedic center. Clin Orthop Relat Res. 2009;467(6):1418–1423. doi: 10.1007/s11999-009-0728-7. - DOI - PMC - PubMed

[7] Parvizi J, Miller AG, Gandhi K. Multimodal pain management after total joint arthroplasty. J Bone Joint Surg Am. 2011;93(11):1075–1084. doi: 10.2106/JBJS.J.01095. - DOI - PubMed

[8] Parvizi J, Miller AG, Gandhi K. Multimodal pain management after total joint arthroplasty. J Bone Joint Surg Am. 2011;93(11):1075–1084. doi: 10.2106/JBJS.J.01095. - DOI - PubMed

[9] Ranawat AS, Ranawat CS. Pain management and accelerated rehabilitation for total hip and total knee arthroplasty. J Arthroplast. 2007;22(7 Suppl 3):12–15. doi: 10.1016/j.arth.2007.05.040. - DOI - PubMed

[10] Ranawat AS, Ranawat CS. Pain management and accelerated rehabilitation for total hip and total knee arthroplasty. J Arthroplast. 2007;22(7 Suppl 3):12–15. doi: 10.1016/j.arth.2007.05.040. - DOI - PubMed

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Risk factors for liposomal bupivacaine resistance after total hip or knee arthroplasties: a retrospective observational cohort in 237 patients

Affiliations

Risk factors for liposomal bupivacaine resistance after total hip or knee arthroplasties: a retrospective observational cohort in 237 patients

Authors

Affiliations

Abstract

Conflict of interest statement

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