BACKGROUND: While opioids remain the cornerstone of postoperative pain control, increasing evidence supports a multimodal approach. One relatively new option in multimodal analgesia is liposomal bupivacaine (LB) for local infiltration of surgical sites with approval for use in peripheral nerve blocks (PNB) anticipated. While several small trials suggest benefits of LB, data on real-world use and effectiveness is lacking. We aim to describe utilization patterns and associations with outcomes among patients undergoing knee arthroplasties under a PNB.
METHODS: Patients undergoing total knee arthroplasties under PNB were identified using the national Premier Perspective claims database (2013-2014; n=32,087; 199 hospitals). Multilevel, multivariable regressions measured associations between LB use and (1) perioperative opioid utilization (in oral morphine equivalents), length and cost of hospitalization, and (2) opioid-related adverse effects including respiratory, gastrointestinal, central nervous system, genitourinary, and “other” complications, and naloxone use as a marker for an opioid-related complication . Odds ratios (OR) and 95% confidence intervals (CI) are reported.
RESULTS: Overall, LB was used in 14.6% (n=4,670) of patients with substantial inter-hospital variation in LB use in these patients: range 0-100%. After controlling for relevant covariates, LB use was associated with a minor but significant -6.6% (CI -9.2;-3.9%) decreased opioid utilization, -4.8% (CI -5.4;-4.1%) decreased length of hospitalization with no significant effect on cost of hospitalization. Interestingly, additional multivariable models demonstrated that LB use was not associated with decreased odds for opioid-related side effects.
CONCLUSION: While LB was used in a minority of patients, its use was associated with a small but significant decrease in opioid utilization and length of hospital stay. However, this did not translate into a decrease in hospital costs or opioid-related adverse effects. This study adds large scale real-world data to the current discussion on the value of LB in perioperative pain management strategies. As our study results do not support clinically meaningful results, future studies should focus on patient subgroups most likely to benefit from the use of LB.