Hospital Pharmacy - May 2017 - 367

715382
research-article2017

HPXXXX10.1177/0018578717715382Hospital PharmacyJacob et al.

Article

Postoperative Pain Management With
Liposomal Bupivacaine in Patients
Undergoing Orthopedic Knee and Hip
Arthroplasty at a Community Hospital

Hospital Pharmacy
2017, Vol. 52(5) 367-373
© The Author(s) 2017
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https://doi.org/10.1177/0018578717715382
DOI: 10.1177/0018578717715382
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Bobby C. Jacob1, Samuel K. Peasah1, Angela O. Shogbon1,
and Ellen R. Perlow1

Abstract
Objective: The objective of this study was to assess the association between liposomal bupivacaine use in patients undergoing
knee or hip arthroplasty and concurrent pain control, length of hospitalization, and physical therapy milestones. Methods:
This was a retrospective chart review. Patients receiving liposomal bupivacaine during a 1-year period (study group) were
compared with patients seen by the same surgeon in the previous year who did not receive liposomal bupivacaine (control
group). Clinical outcomes included concurrent opioid use, average pain scores, length of stay, ambulation, and range of
motion. Results: A total of 357 patients were included in the study. Knee study group patients received lower amounts of
opioid (209 vs 248 mg; P = .02) and had a delayed time to first rescue medication (6.3 ± 4.7 vs 5.0 ± 4.4 hours; P = .02). Hip
study group patients had a delay in time to first rescue medication (7.1 ± 6.3 vs 4.9 ± 4.0 hours; P = .046). Both knee and hip
study group patients had higher average pain score during the 72-hour postoperative period (6.38 vs 6.06; P = .01, and 6.32
vs 5.80; P = .02, respectively) but decreased median length of stay (2.0 vs 3.0 days; P < .0001, and 2.0 vs 3.0 days; P = .04,
respectively). Conclusions: Use of liposomal bupivacaine produced a modest decrease in opioid use among knee patients
and a decreased length of stay in both knee and hip patients; however, this was accompanied by a non-clinically significant
increase in pain scores for knee and hip patients suggesting limited utility for orthopedic procedures.
Keywords
hip arthroplasty, knee arthroplasty, liposomal bupivacaine, pain management

The Centers for Disease Control and Prevention estimates
that there were 719 000 knee replacement surgeries and 332
000 hip replacement surgeries in the United States during
2010.1 In the United States, the lifetime risk for total knee
replacement has been estimated to be 7% for males and 9.5%
for females.2 Epidemiological studies have demonstrated
similar risks for total hip replacement.3,4 Historically, postoperative pain has been recognized as a significant complication with surgical procedures, and it is defined by the
American Society of Anesthesiologists as any pain that is
present in a surgical patient after a procedure.5-7 Current
practice is to adopt a multimodal analgesic strategy during
the perioperative period, which uses a combination of techniques and medications that target different components of
the nociceptive pathway.8,9 Approaches to pain management
include neuraxial anesthesia, peripheral nerve blockades,
periarticular injections with local anesthetics, and use of
analgesic medications including opioids, selective and nonselective nonsteroidal anti-inflammatory drugs (NSAID),
acetaminophen, gabapentionoids, ketamine, and alpha-2

agonists.10 Medications are a significant part of this strategy,
and the combination of medications with differing mechanisms is thought to result in additive or synergistic analgesia
with a lower incidence of overall adverse events.9 Several
studies have validated the benefits of a multimodal analgesic
strategy in orthopedic procedures.11-14
Liposomal bupivacaine was approved by the US Food
and Drug Administration (FDA) in 2011 for administration
into surgical sites to produce postsurgical analgesia.15 The
product is formulated using multivesicular liposomes encapsulating bupivacaine, which allows for prolonged release of
bupivacaine for up to 72 hours after injection.16 Approval in
the United States was based on 2 pivotal trials conducted in
1

Mercer University, Atlanta, GA, USA

Corresponding Author:
Bobby C. Jacob, Clinical Assistant Professor, Department of Pharmacy
Practice, College of Pharmacy, Mercer University, 3001 Mercer University
Drive, Atlanta, GA 30341, USA.
Email: Jacob_bc@mercer.edu


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Table of Contents for the Digital Edition of Hospital Pharmacy - May 2017

Editorial, For Sale: FDA Priority Review Vouchers
Current FDA-Related Drug Information; Approvals, Submission, and Important Labeling Changes for US Marketed Pharmaceuticals
Summaries of Safety Labeling Changes Approved by the FDA: Boxed Warnings
ISMP Adverse Drug Reactions: Levofloxacin-Induced Neuroexcitation and Hallucinations Statin-Induced Muscle Rupture Mefloquine-Induced Rhabdomyolysis Methimazole-Induced
Critical Care Pharmacist Market Perceptions: Comparison of Critical Care Program Directors and Directors of Pharmacy
Capecitabine, Oxaliplatin, and Bevacizumab (BCapOx) Regimen for Metastatic Colorectal Cancer
Clinical Pharmacy Discharge Counseling Service and the Impact on Readmission Rates in High-Risk Patients
Mannitol Prescribing Practices With Cisplatin Before and After an Educational Newsletter Intervention
Pharmacists’ Knowledge of the Cost of Laboratory Testing
Adverse Drug Reaction Reporting Practices Among United Arab Emirates Pharmacists and Prescribers
Postoperative Pain Management With Liposomal Bupivacaine in Patients Undergoing Orthopedic Knee and Hip Arthroplasty at a Community Hospital
Formulary Drug Reviews
Hospital Pharmacy - May 2017 - 317
Hospital Pharmacy - May 2017 - 318
Hospital Pharmacy - May 2017 - 319
Hospital Pharmacy - May 2017 - 320
Hospital Pharmacy - May 2017 - 321
Hospital Pharmacy - May 2017 - 322
Hospital Pharmacy - May 2017 - 323
Hospital Pharmacy - May 2017 - Editorial, For Sale: FDA Priority Review Vouchers
Hospital Pharmacy - May 2017 - 325
Hospital Pharmacy - May 2017 - Current FDA-Related Drug Information; Approvals, Submission, and Important Labeling Changes for US Marketed Pharmaceuticals
Hospital Pharmacy - May 2017 - Summaries of Safety Labeling Changes Approved by the FDA: Boxed Warnings
Hospital Pharmacy - May 2017 - 328
Hospital Pharmacy - May 2017 - 329
Hospital Pharmacy - May 2017 - ISMP Adverse Drug Reactions: Levofloxacin-Induced Neuroexcitation and Hallucinations Statin-Induced Muscle Rupture Mefloquine-Induced Rhabdomyolysis Methimazole-Induced
Hospital Pharmacy - May 2017 - 331
Hospital Pharmacy - May 2017 - 332
Hospital Pharmacy - May 2017 - 333
Hospital Pharmacy - May 2017 - Critical Care Pharmacist Market Perceptions: Comparison of Critical Care Program Directors and Directors of Pharmacy
Hospital Pharmacy - May 2017 - 335
Hospital Pharmacy - May 2017 - 336
Hospital Pharmacy - May 2017 - 337
Hospital Pharmacy - May 2017 - 338
Hospital Pharmacy - May 2017 - 339
Hospital Pharmacy - May 2017 - 340
Hospital Pharmacy - May 2017 - Capecitabine, Oxaliplatin, and Bevacizumab (BCapOx) Regimen for Metastatic Colorectal Cancer
Hospital Pharmacy - May 2017 - 342
Hospital Pharmacy - May 2017 - 343
Hospital Pharmacy - May 2017 - 344
Hospital Pharmacy - May 2017 - 345
Hospital Pharmacy - May 2017 - 346
Hospital Pharmacy - May 2017 - 347
Hospital Pharmacy - May 2017 - Clinical Pharmacy Discharge Counseling Service and the Impact on Readmission Rates in High-Risk Patients
Hospital Pharmacy - May 2017 - 349
Hospital Pharmacy - May 2017 - 350
Hospital Pharmacy - May 2017 - 351
Hospital Pharmacy - May 2017 - 352
Hospital Pharmacy - May 2017 - Mannitol Prescribing Practices With Cisplatin Before and After an Educational Newsletter Intervention
Hospital Pharmacy - May 2017 - 354
Hospital Pharmacy - May 2017 - 355
Hospital Pharmacy - May 2017 - 356
Hospital Pharmacy - May 2017 - Pharmacists’ Knowledge of the Cost of Laboratory Testing
Hospital Pharmacy - May 2017 - 358
Hospital Pharmacy - May 2017 - 359
Hospital Pharmacy - May 2017 - 360
Hospital Pharmacy - May 2017 - Adverse Drug Reaction Reporting Practices Among United Arab Emirates Pharmacists and Prescribers
Hospital Pharmacy - May 2017 - 362
Hospital Pharmacy - May 2017 - 363
Hospital Pharmacy - May 2017 - 364
Hospital Pharmacy - May 2017 - 365
Hospital Pharmacy - May 2017 - 366
Hospital Pharmacy - May 2017 - Postoperative Pain Management With Liposomal Bupivacaine in Patients Undergoing Orthopedic Knee and Hip Arthroplasty at a Community Hospital
Hospital Pharmacy - May 2017 - 368
Hospital Pharmacy - May 2017 - 369
Hospital Pharmacy - May 2017 - 370
Hospital Pharmacy - May 2017 - 371
Hospital Pharmacy - May 2017 - 372
Hospital Pharmacy - May 2017 - 373
Hospital Pharmacy - May 2017 - Formulary Drug Reviews
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Hospital Pharmacy - May 2017 - 376
Hospital Pharmacy - May 2017 - 377
Hospital Pharmacy - May 2017 - 378
Hospital Pharmacy - May 2017 - 379
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