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. 2024 Feb 1;6(1):6.
doi: 10.1186/s42836-023-00226-y.

A prospective, randomized trial of liposomal bupivacaine compared to conventional bupivacaine on pain control and postoperative opioid use in adults receiving adductor canal blocks for total knee arthroplasty

Aurora Quaye  1   2   3   4 , Brian McAllister  5   6   7 , Joseph R Garcia  5   6   7   8 , Orion Nohr  5   6   7   8 , Sarah J Laduzenski  5   6   7 , Lucy Mack  5   7 , Christine R Kerr  6 , Danielle A Kerr  6 , Charonne N Razafindralay  9 , Janelle M Richard  6 , Wendy Y Craig  8   10 , Stephen Rodrigue  11
Affiliations

A prospective, randomized trial of liposomal bupivacaine compared to conventional bupivacaine on pain control and postoperative opioid use in adults receiving adductor canal blocks for total knee arthroplasty

Aurora Quaye et al. Arthroplasty. .

Abstract

Background: Total knee arthroplasty (TKA) is a commonly performed procedure to alleviate pain and improve functional limitations caused by end-stage joint damage. Effective management of postoperative pain following TKA is crucial to the prevention of complications and enhancement of recovery. Adductor canal blocks (ACB) with conventional bupivacaine (CB) provide adequate analgesia after TKA, but carry a risk of rebound pain following block resolution. Liposomal bupivacaine (LB) is an extended-release local anesthetic that can provide up to 72 h of pain relief. The objective of this study was to compare postoperative outcomes between ACBs using LB and CB after TKA.

Methods: This single institution, prospective, randomized, clinical trial enrolled patients scheduled for TKA. Participants were randomized to receive ACB with either LB or CB. Pain scores up to 72 h postoperatively were assessed as the primary outcome. Opioid consumption and length of stay were evaluated as secondary outcomes.

Results: A total of 80 patients were enrolled. Demographic and clinical characteristics were similar between the two groups. LB group showed significantly lower cumulative opioid use during the 72 h evaluated (P = 0.016). There were no differences in pain scores or length of stay between the groups.

Conclusion: The study demonstrated that LB ACBs led to significantly lower opioid consumption in the days following TKA without affecting pain scores or length of stay. This finding has important implications for improving postoperative outcomes and reducing opioid use in TKA patients. Previous studies have reported inconsistent results regarding the benefits of LB, highlighting the need for further research.

Trial registration: This project was retrospectively registered with clinicaltrials.gov ( NCT05635916 ) on 2 December 2022.

Keywords: Anesthetics; Arthroplasty; Knee; Local; Nerve block; Pain; Postoperative; Regional anesthesia; Replacement.

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Conflict of interest statement

The authors have no competing interests to declare.

Figures

Fig. 1
Fig. 1
CONSORT diagram
Fig. 2
Fig. 2
Overall opioid dose (MME), by time period after total knee arthroplasty, stratified by ACB bupivacaine type ACB, adductor canal block; MME, milligram morphine equivalents; PACU, post-anesthesia care unit; POD, postoperative day (defined as consecutive 24 h periods following discharge from the PACU); SE, standard error. a Mean (SE) opioid dose at each time point was estimated by repeated measures ANOVA; MME was entered as zero when a participant did not receive opioids
See this image and copyright information in PMC

References

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