Liposomal Bupivacaine for Postoperative Pain: Not Opioid-Sparing

A database analysis published this month in the journal Anesthesiology concludes that the use of the local anesthetic liposomal bupivacaine as part of a multimodal approach to postsurgical pain management is unlikely to be effective as an opioid-sparing strategy. A combination of opioids, nonopioid analgesics, and local anesthetics has been increasingly advocated as a route to providing postsurgical pain treatment while minimizing the need for opioids and reducing the risk of opioid related adverse effects. But local anesthetics provide only short-term pain relief, and physician anesthesiologists had hoped that liposomal bupivacaine, a long-acting version of bupivacaine that is formulated in a new lipid-based structure, might offer a solution.

Senior study author Stavros Memtsoudis, MD, PhD, director of critical care services at Hospital for Special Surgery, New York, commented, “Local anesthesia is one mode that has been proposed as being part of a multimodal approach to reducing opioid consumption. But we found that adding liposomal bupivacaine to the mix did not add significant benefit.” Dr. Memtsoudis and colleagues examined data from 88,830 patients who underwent total knee replacement between 2013 and 2016, and who received a peripheral nerve block as part of a multimodal pain regimen. 21% of the study subjects had received liposomal bupivacaine in conjunction with a peripheral nerve block, and the rate of administration increased from 7% to 26% of patients between 2013 1nd 2016. But this group experienced no better outcomes on measures of amount of opioids prescribed, length of hospital stay, or incidence of opioid related complications than others in the study population. Dr. Memtsoudis concluded: “The routine use of liposomal bupivacaine should be carefully examined, especially given its relatively high cost. It does not seem to be the silver bullet physicians have been hoping for.”

Read a news story about the research conclusions.

The journal abstract may be read here.