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benefits in one type of procedure may not predict success in
other patients. This study adds to the knowledge regarding
the value of liposomal bupivacaine use for orthopedic hip
procedures from a rehabilitation perspective by examining
the effect on distance ambulation. There were no significant
improvements in distance of ambulation on most days; however, there was an unexplained significant increase on day 2.
Previous studies have not examined physical therapy milestones so further studies in randomized controlled designs
are warranted on any potential benefits.
No significant differences in either knee or hip patients
were noted with respect to adverse events, except as related
to nausea. The validity of these findings may be limited,
because documentation of adverse events in the electronic
medical chart had significant missing data. The decreased
need for opioid medications is beneficial in improving participation in physical therapy as patients can focus on
advanced skills, such as stair climbing, needed for discharge.
Increased opioid use can contribute to decreased safety
awareness and unnecessary falls.35 While the shorter length
of hospitalization may have minimal direct economic implications, there is a potential benefit in decreasing the risk of
infection and thromboembolism from the hospital environment. Further studies are warranted to quantify the potential
health economic benefits in this setting.
There are a number of limitations for this study including
the retrospective study design, comparison to a historical
cohort group, and significant missing data for adverse events.
Having all patients seen by a single surgeon would theoretically limit any bias or confounding related to surgical technique. Multivariate regression analysis to minimize any
effects of confounding variables adds rigor to the analysis.

Conclusion
The use of intraoperative liposomal bupivacaine was beneficial during orthopedic knee procedures in producing a relatively modest reduction in concurrent postoperative opioid
analgesic medication; however, similar results were not seen
in patients having orthopedic hip procedures. Both groups of
patients experienced a delay in first opioid rescue pain medication but no clinically significant improvement in overall
pain management during the 72-hour postoperative period.
Differences in ambulation between groups were limited.
These findings suggest a limited role for liposomal bupivacaine in achieving positive health outcomes for patients
undergoing orthopedic knee or hip procedures.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.

Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.

Hospital Pharmacy 52(5)
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https://www.cdc.gov/nchs/data/nhds/4procedures/2010pro4_numberprocedureage.pdf https://www.cdc.gov/nchs/data/nhds/4procedures/2010pro4_numberprocedureage.pdf

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