Liposomal bupivacaine in total hip arthroplasty: Do the results justify the cost?

Abstract Introduction Liposomal bupivacaine has a paucity of data regarding narcotic requirements and hospital length of stay in comparison to other peri-articular injections, specifically in the total hip arthroplasty (THA) population. Methods 69 patients who underwent THA by a single surgeon were...

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Bibliographic Details
Published in:Journal of orthopaedics 2017-03, Vol.14 (1), p.161-165
Main Authors: Beachler, Jason A, Kopolovich, Daniel M, Tubb, Creighton C, Sayeed, Siraj A
Format: Article
Language:English
Subjects:
Length of stay
Liposomal bupivacaine
Narcotic requirement
Original
Orthopedics
THA cost
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Summary:Abstract Introduction Liposomal bupivacaine has a paucity of data regarding narcotic requirements and hospital length of stay in comparison to other peri-articular injections, specifically in the total hip arthroplasty (THA) population. Methods 69 patients who underwent THA by a single surgeon were divided into two cohorts over a 3 year period in this retrospective study comparing narcotic requirements, hospital length of stay and cost. The study group (n = 29) received liposomal bupivacaine whereas a matched control group (n = 40) received a pharmacy-mixed cocktail in peri-articular structures. Statistical and clinical differences were reported in this unfunded study. Results No difference was found in hospital length of stay [2.9 days in the study group (range 1–14) versus 3.1 days (range 1–11) in the control group, p = 0.101], however, the study group required less narcotics per day [22.6 mg (range 5–53.3) versus 29 mg (range 6.7–80.8) in the control group, p = 0.045]. The clinical difference between cohorts averaged less than one pill per day of hospitalization. The cost per patient of the local injection was more than 11 times greater in the liposomal bupivacaine group. Conclusion Liposomal bupivacaine demonstrated a statistical improvement in narcotic requirements but not in hospital length of stay in comparison to a control group. The effects of liposomal bupivacaine on narcotic requirements and hospital length of stay may not justify its use in total hip arthroplasty patients given the substantial cost of these injections and the minimal clinical difference in outcomes compared to a more cost-effective injection.
ISSN:0972-978X
0972-978X
DOI:10.1016/j.jor.2016.12.008