Hospital Pharmacy - May 2017 - 369

369

Jacob et al.
Table 1. Baseline Characteristics of Knee and Hip Arthroplasty Patients.
Knee (n = 244)
a

b

Hip (n = 113)
Study (n = 68)

Controlb (n = 45)

Pc

.9995
.5190

62 ± 13
50.7%

62 ± 11
65.2%

.9241
.1246

.7179

42.0%
52.2%
5.8%

37.0%
60.9%
2.2%

.1936

Study (n = 133)

Control (n = 111)

P

63 ± 11
66.7%

63 ± 10
70.4%

53.2%
41.8%
5.0%

54.8%
41.7%
3.5%

Age, y, mean ± SD
Female
Race
White
Black
Other

c

a

Note. Statistical significance for differences between the groups was set at P < .05.
a
The study group included patients who received liposomal bupivacaine.
b
The control group included patients who did not receive liposomal bupivacaine.
c
The study group and control group were compared with respect to baseline characteristics.

analyzed using Mann-Whitney U test. Furthermore, multivariate regression was used to estimate the association
between the use of liposomal bupivacaine and these variables while controlling for age, gender, or race. SAS software, version 9.3 (SAS Inc, Cary, North Carolina) was used
for the analyses.

Results
Patient Characteristics
The study included a total of 357 patients over a 2-year
period. A total of 201 patients received liposomal bupivacaine, including 133 patients who underwent knee procedures and 68 patients who underwent hip procedures. The
historical control group comprised 156 patients; of these, 111
patients underwent knee procedures and 45 patients had hip
procedures. The average age of participants was 63 ± 11
years. No statistically significant differences were noted
between any of the groups with respect to age, gender, or
race (Table 1).

Knee Procedures
Patients in the knee study group, compared with those in the
control group, received significantly lower amounts of opioid pain medication over the 72-hour postoperative period
(209.4 ± 117.3 vs 247.8 ± 148.3 in milligrams of morphine
equivalents; P < .05) (Table 2) and had a significantly
delayed time to first rescue pain medication (4.0 [2.8-8.0] vs
3.0 [2.0-6.0] hours; P < .05) (Table 2). Average pain scores
for the 72-hour postoperative period, however, were significantly higher in the study group (6.38 ± 0.96 vs 6.06 ± 1.05;
P < .05). There were no significant differences in average
pain score by 24-hour intervals between the groups. In addition, the median length of hospitalization was shorter in the
study group than in the control group (2.0 [2.0-3.0] vs 3.0
[2.0-3.0] days; P < .0001). The results of the multivariate
regression analysis were consistent with the findings above

showing liposomal bupivacaine associated with decreased
opioid use, delayed time to first analgesic medication,
decreased length of hospitalization, and increased average
pain score (Table 3). In this analysis, as age increased,
patients were found to have less total opioid consumed and
took longer time to ask for the first analgesic medication. In
addition, females stayed longer in the hospital prior to discharge than males.
There were no significant differences in ambulation distance between study and control group patients (Table 4).
The degrees of knee flexion range of motion for the control
group were significantly higher than the study group on day
2 after surgery (96 vs 92; P < .05) and day 3 after surgery (97
vs 93; P < .05). There were no other significant differences in
range of motion observed between groups. Patients receiving
liposomal bupivacaine were significantly less likely to complain of nausea (31.2% vs 45.2%; P < .001). No other statistically significant differences between groups were noted in
other adverse events.

Hip Procedures
Unlike the knee study group patients, there were no significant
differences in opioid consumption during the postoperative
phase noted between study and control groups; however, there
was a statistically significant delay in time to first rescue pain
medication for those patients receiving liposomal bupivacaine
(5.0 [3.0-10.0] vs 3.0 [2.0-6.0] hours; P < .05) (Table 2).
Similar to knee patients, there was also a higher average pain
score during the 72-hour postoperative time period for patients
receiving liposomal bupivacaine compared with the control
group (6.32 ± 1.12 vs 5.80 ± 1.27; P < .05). Furthermore, the
average pain score during postoperative day 2 (25-48 hours
post-op) was significantly higher in the study group (6.33 ±
1.32 vs 5.81 ± 1.39; P < .05). The median length of hospitalization was lower in the study group (2.0 [2.0-3.0] vs 3.0 [2.03.0]; P < .05). Findings from multivariate regression analysis
were consistent with the results above showing delayed time
to first rescue analgesic medication, reduced length of



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
Hospital Pharmacy - May 2017 - 375
Hospital Pharmacy - May 2017 - 376
Hospital Pharmacy - May 2017 - 377
Hospital Pharmacy - May 2017 - 378
Hospital Pharmacy - May 2017 - 379
Hospital Pharmacy - May 2017 - 380
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