Newly Published
Perioperative Medicine  |   May 2018
Liposomal Bupivacaine Does Not Reduce Inpatient Opioid Prescription or Related Complications after Knee Arthroplasty: A Database Analysis
Author Notes
  • From the Department of Anesthesiology, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York (L.P., C.C., S.G.M.); Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria (L.P., C.C., S.G.M.); Icahn School of Medicine at Mount Sinai, New York, New York (J.P., N.Z., M.M.); and Stanford University, Stanford, California (E.C.S.).
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • An abstract of this study was presented as a poster at the 42nd Annual Regional Anesthesiology and Acute Pain Medicine Meeting in San Francisco, California, April 6–8, 2017.
    An abstract of this study was presented as a poster at the 42nd Annual Regional Anesthesiology and Acute Pain Medicine Meeting in San Francisco, California, April 6–8, 2017.×
  • Submitted for publication October 4, 2017. Accepted for publication April 26, 2018.
    Submitted for publication October 4, 2017. Accepted for publication April 26, 2018.×
  • Research Support: Supported by National Institute on Drug Abuse, Rockville, Maryland, grant No. K08DA032314 (to Dr. Sun), consulting fees unrelated to this work from Egalet Inc., Wayne, Pennsylvania (to Dr. Sun) and by the Tisch Cancer Institute at Mount Sinai, New York, New York (to Dr. Mazumdar and Dr. Poeran). For all the other authors, support was provided solely from institutional and/or departmental sources.
    Research Support: Supported by National Institute on Drug Abuse, Rockville, Maryland, grant No. K08DA032314 (to Dr. Sun), consulting fees unrelated to this work from Egalet Inc., Wayne, Pennsylvania (to Dr. Sun) and by the Tisch Cancer Institute at Mount Sinai, New York, New York (to Dr. Mazumdar and Dr. Poeran). For all the other authors, support was provided solely from institutional and/or departmental sources.×
  • Competing Interests: Dr. Memtsoudis is a director on the boards of the American Society of Regional Anesthesia and Pain Medicine, Pittsburgh, Pennsylvania, and the Society of Anesthesia and Sleep Medicine, Milwaukee, Wisconsin. He is a one-time consultant for Sandoz Inc., Princeton, New Jersey, and the holder of U.S. Patent US-2017-0361063, Multicatheter Infusion System. He is the owner of SGM Consulting, LLC, Rumson, New Jersey, and co-owner of FC Monmouth, LLC, Fairhaven, New Jersey. None of the above relations influenced the conduct of the present study. The other authors declare no competing interests.
    Competing Interests: Dr. Memtsoudis is a director on the boards of the American Society of Regional Anesthesia and Pain Medicine, Pittsburgh, Pennsylvania, and the Society of Anesthesia and Sleep Medicine, Milwaukee, Wisconsin. He is a one-time consultant for Sandoz Inc., Princeton, New Jersey, and the holder of U.S. Patent US-2017-0361063, Multicatheter Infusion System. He is the owner of SGM Consulting, LLC, Rumson, New Jersey, and co-owner of FC Monmouth, LLC, Fairhaven, New Jersey. None of the above relations influenced the conduct of the present study. The other authors declare no competing interests.×
  • Correspondence: Address correspondence to Dr. Memtsoudis: Hospital for Special Surgery Department of Public Health, Weill Cornell Medical College, 535 East 70th Street, New York, New York 10021. memtsoudiss@hss.edu. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Pain Medicine / Pharmacology / Opioid
Perioperative Medicine   |   May 2018
Liposomal Bupivacaine Does Not Reduce Inpatient Opioid Prescription or Related Complications after Knee Arthroplasty: A Database Analysis
Anesthesiology Newly Published on May 21, 2018. doi:10.1097/ALN.0000000000002267
Anesthesiology Newly Published on May 21, 2018. doi:10.1097/ALN.0000000000002267
Abstract

Background: Although some trials suggest benefits of liposomal bupivacaine, data on real-world use and effectiveness is lacking. This study analyzed the impact of liposomal bupivacaine use (regardless of administration route) on inpatient opioid prescription, resource utilization, and opioid-related complications among patients undergoing total knee arthroplasties with a peripheral nerve block. It was hypothesized that liposomal bupivacaine has limited clinical influence on the studied outcomes.

Methods: The study included data on 88,830 total knee arthroplasties performed with a peripheral nerve block (Premier Healthcare Database 2013 to 2016). Multilevel multivariable regressions measured associations between use of liposomal bupivacaine and (1) inpatient opioid prescription (extracted from billing) and (2) length of stay, cost of hospitalization, as well as opioid-related complications. To reflect the difference between statistical and clinical significance, a relative change of −15% in outcomes was assumed to be clinically important.

Results: Overall, liposomal bupivacaine was used in 21.2% (n = 18,817) of patients that underwent a total knee arthroplasty with a peripheral nerve block. Liposomal bupivacaine use was not associated with a clinically meaningful reduction in inpatient opioid prescription (group median, 253 mg of oral morphine equivalents, adjusted effect −9.3% CI −11.1%, −7.5%; P < 0.0001) and length of stay (group median, 3 days, adjusted effect −8.8% CI −10.1%, −7.5%; P < 0.0001) with no effect on cost of hospitalization. Most importantly, liposomal bupivacaine use was not associated with decreased odds for opioid-related complications.

Conclusions: Liposomal bupivacaine was not associated with a clinically relevant improvement in inpatient opioid prescription, resource utilization, or opioid-related complications in patients who received modern pain management including a peripheral nerve block.