Liposomal bupivacaine versus plain bupivacaine in periarticular injection for control of pain and early motion in total knee arthroplasty: A randomized prospective study
Jason P. Zlotnicki, MD, Brian R. Hamlin, MD, Anton Y. Plakseychuk, MD PhD, Timothy J. Levison, MS, Scott Rothenberger, PhD, and Kenneth Urish, MD PhDKnee
Background
The use of mulitmodal pain regimens have been shown to be an effective technique for the treatment of post-operative pain after total knee arthroplasty. Periarticular injections, of both short and long acting anesthetics, have emerged as an additional method of providing significant improvement in post-operative pain relief. The purpose of this study was to compare the efficacy of periarticular injection using long-acting versus short-acting preparations.
Methods
A randomized prospective study of 80 consecutive patients was performed comparing liposomal bupivacaine versus plain bupivacaine periarticular injection. The primary outcomes included pain relief, total narcotic usage, and completion of physical therapy goals, specifically range-of-motion.
Results
No significant improvements were noted between liposomal bupivacaine and plain bupivacaine injection groups in overall pain reduction, range of motion or total narcotic usage. At 24 hours, small statistically significant differences in physical therapy pain scores were noted with liposomal bupivacaine versus plain bupivacaine and control patients, but these differences did not persist at later time points. Both preparations demonstrated statistically significant improvements in range of motion when compared to historical controls, but no differences were noted between preparations.
Conclusion
Overall, minimal significant differences were noted between liposomal bupivacaine and plain bupivacaine at early and late time points. Both preparations of periarticular injection demonstrated superiority over control pain regimens, but were relatively equivalent to one another in direct comparison
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