New formulation of bupivacaine does not reduce opioid use after TKA

Editor's Note

Contrary to what some studies are suggesting, use of the local anesthetic liposomal bupivacaine as part of a multimodal approach to postoperative pain did not reduce in-hospital opioid use or opioid-related complications after total knee arthroplasty (TKA) in this study.

Researchers analyzed data on 88,830 TKAs performed with a peripheral nerve block−one group had a peripheral nerve block and general anesthesia and one group had a peripheral nerve block and regional anesthesia. Overall, liposomal bupivacaine was used in 18,817 (21.2%) of procedures.

Use of liposomal bupivacaine was not associated with a clinically meaningful reduction in inpatient opioid use or length of stay and had no effect on cost of hospitalization or opioid-related complications.

The routine use of liposomal bupivacaine should be carefully examined; it does not appear to be the “silver bullet” physicians have been hoping for, the researchers say.