Hospital Pharmacy - May 2017 - 370

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Table 2. Clinical Outcomes of Knee and Hip Arthroplasty Patients.
Knee (n = 244)a
Study (n = 133)
Opioid consumption, mg
Time to first pain med, hours
Pain score, 0-72 hours
Pain score immediately post-op
Pain score, 0-24 hours
Pain score, 25-48 hours
Pain score, 49-72 hours
Length of hospitalization, days

209.4 ± 117.3
6.3 ± 4.7
4.0 (2.8-8.0)
6.38 ± 0.96
4.87 ± 3.59
6.44 ± 1.32
6.36 ± 1.07
5.75 ± 1.51
2.44 ± 0.55
2.0 (2.0-3.0)

Hip (n = 113)b

Control (n = 111)
247.8 ± 148.3
5.0 ± 4.4
3.0 (2.0-6.0)
6.06 ± 1.05
5.42 ± 3.62
6.16 ± 1.26
6.12 ± 1.20
5.33 ± 1.61
2.76 ± 0.62
3.0 (2.0-3.0)

P

Study (n = 68)

Control (n = 45)

P

.02
.03

194.1 ± 119.5
7.1 ± 6.3
5.0 (3.0-10.0)
6.32 ± 1.12
4.84 ± 3.72
6.34 ± 1.49
6.33 ± 1.32
6.33 ± 1.27
2.49 ± 0.5
2.0 (2.0-3.0)

203.0 ± 102.6
4.9 ± 4.0
3.0 (2.0-6.0)
5.80 ± 1.27
6.48 ± 3.46
5.88 ± 1.49
5.81 ± 1.39
5.88 ± 1.87
2.74 ± 0.71
3.0 (2.0-3.0)

.68
.046

.01
.226
.08
.10
.12
<.0001

.02
.02
.10
.046
.26
.04

Note. Values given as mean ± standard deviation and median with interquartile range.
a
The study group included knee patients who received liposomal bupivacaine and the control group included knee patients who did not receive liposomal
bupivacaine. The study and control groups were compared with respect to clinical outcomes. Statistical significance for differences between the groups
was set at a P value of <.05.
b
The study group included hip patients who received liposomal bupivacaine and the control group included hip patients who did not receive liposomal
bupivacaine. The study and control group for hip patients were compared with respect to clinical outcomes. Statistical significance for differences between
the groups was set at a P value <.05.

Table 3. Multivariate Analysis of Outcomes of Interest of Knee and Hip Arthroplasty Patients.
Average pain score

Opioid consumption in
morphine equivalents, mg

Time to first pain
medication, hours

Length of hospitalization,
days

Variable

Knee
(n = 244)

Hip
(n = 113)

Knee
(n = 244)

Hip
(n = 113)

Knee
(n = 244)

Hip
(n = 113)

Knee
(n = 244)

Hip
(n = 113)

LB vs no LB
Age, years
Female vs male
Asian vs White
Black vs White
Hispanic vs White

0.3154**
−0.0223**
0.2009
0.5806
0.2375
0.4131

0.5091*
−0.0109
0.0565
−0.2450
0.5933*
1.0934

−39.7245**
−5.5057**
−3.9151
39.9326
−2.0876
−56.5897

−11.4665
−2.7004**
−27.8030
−104.4973
6.6426
−43.4955

1.3007*
0.0987**
−0.8714
−0.4095
0.2293
0.9204

2.3507*
0.0330
−1.0063
13.2360*
0.5616
−0.6067

−0.3138**
0.0065
0.1868*
0.2837
0.1423
0.3181

−0.2406*
0.0081
0.1444
−0.6059
0.2470
0.3740

Note. Multivariate regression was performed to determine the association between use of LB, gender, and race with average pain score, opioid
consumption in morphine equivalents, time to first pain medication, and length of stay. LB = liposomal bupivacaine.
*P < .05. **P < .01.

hospitalization, and higher pain scores. Age was associated
with a marginally lower total opioid consumption. In addition,
Asian race was associated with a delayed time to first pain
medication and higher average pain scores. Like the knee
patients, there were only minimal differences between groups
with respect to distance ambulated (Table 5). Study hip
patients had a higher distance ambulated on day 2 after surgery compared with controls (335 ft vs 238 ft; P = .04); however, no other differences in ambulation were noted between
groups. Similar to the knee patients, significantly fewer study
group patients experienced nausea compared with the control
group (24.6% vs 37.0%; P < .001).

Discussion
We evaluated a large ethnically diverse patient population
undergoing knee or hip arthroplasty performed by a single

surgeon in a community hospital setting. Among patients
undergoing orthopedic knee procedures, liposomal bupivacaine use was associated with a significant decrease in use of
postoperative opioid analgesic medication of approximately
40 mg in morphine equivalents and delayed time to first opioid analgesic. Patients undergoing orthopedic hip procedures
who received liposomal bupivacaine had similar outcomes
with respect to delayed time to first opioid analgesic; however, no significant benefits were achieved in terms of reducing concurrent opioid analgesic medication use. Average
pain scores for the 72-hour postoperative period were actually higher among knee and hip patients who received liposomal bupivacaine. These findings suggest that while
liposomal bupivacaine may reduce the need for postoperative opioid analgesic medications, there appears to be no
benefit in improving overall pain control. The decreased
length of stay associated with liposomal bupivacaine 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
Hospital Pharmacy - May 2017 - 381
Hospital Pharmacy - May 2017 - 382
Hospital Pharmacy - May 2017 - 383
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