Editorial Views  |   October 2018
Liposomal Bupivacaine Infiltration for Knee Arthroplasty: Significant Analgesic Benefits or Just a Bunch of Fat?
Author Notes
  • From the Department of Anesthesiology, University of California San Diego, San Diego, California (B.M.I., R.A.G.); the Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina ( J.C.E.); and the Outcomes Research Consortium, Cleveland, Ohio (B.M.I., R.A.G.).
  • Corresponding article on page 689.
    Corresponding article on page 689.×
  • Accepted for publication July 7, 2018.
    Accepted for publication July 7, 2018.×
  • Address correspondence to Dr. Ilfeld: bilfeld@ucsd.edu
Article Information
Editorial Views / Pain Medicine / Pharmacology
Editorial Views   |   October 2018
Liposomal Bupivacaine Infiltration for Knee Arthroplasty: Significant Analgesic Benefits or Just a Bunch of Fat?
Anesthesiology 10 2018, Vol.129, 623-626. doi:10.1097/ALN.0000000000002386
Anesthesiology 10 2018, Vol.129, 623-626. doi:10.1097/ALN.0000000000002386
TOTAL knee arthroplasty is among the most common and painful surgical procedures, with more than 700,000 performed annually in the United States alone. Infiltration of the surgical site with local anesthetic is frequently performed by surgeons to provide postoperative analgesia, although the duration of action is limited to that of the longest-acting local anesthetic available, bupivacaine. By encasing standard bupivacaine in liposomes, the duration of local anesthetic release may be prolonged as the liposomes break down and emit the active medication. In 2011, the first (and currently only) liposomal bupivacaine formulation was approved by the U.S. Food and Drug Administration for surgical wound infiltration (Exparel; Pacira Pharmaceuticals, Inc., USA). In the interim, multiple randomized, controlled clinical trials have been published and, while this type of study design has advantages such as determining effectiveness while minimizing confounding, it also has limitations including modest sample size and uncertain generalizability to daily practice.