Liposomal bupivacaine exhibits no benefit in postoperative ache administration for older adults

For older adults present process hemiarthroplasty for hip fracture, intraoperative use of liposomal bupivacaine doesn’t enhance ache scores or different related outcomes, in comparison with typical bupivacaine, reviews a research in The Journal of Bone & Joint Surgical procedure. The journal is printed within the Lippincott portfolio by Wolters Kluwer. 

“Use of liposomal bupivacaine will not be related to considerably improved postoperative ache or operate or with a shorter hospital course following hip hemiarthroplasty for a femoral neck fracture,” in keeping with the medical trial report by Mitchell Ok. Ng, MD, and colleagues of Maimonides Medical Middle, Brooklyn, New York. 

Randomized trial of liposomal bupivacaine for hip fracture surgical procedure 

Liposomal bupivacaine is a long-acting native anesthetic developed to be used in relieving postoperative ache, permitting drug launch over as much as 72 hours. Research have proven that liposomal bupivacaine can scale back ache after numerous surgical procedures, together with complete knee or hip arthroplasty. Few research have assessed its use following hip fracture surgical procedure. 

The brand new medical trial enrolled 50 older adults present process hip hemiarthroplasty for remoted intracapsular femoral neck fractures. Sufferers have been randomly assigned to intraoperative injection of both liposomal bupivacaine or commonplace bupivacaine hydrochloride. In each teams, a collection of injections have been made across the reconstructed joint towards the tip of the process. 

Ache scores, complete opioid dose, and time to ambulate have been assessed in blinded vogue. Time to hospital discharge, security, and a spread of secondary outcomes have been evaluated as properly. 

The outcomes confirmed no vital distinction in ache scores with liposomal bupivacaine (2.3) versus commonplace bupivacaine (2.7), with scores remaining comparable all through the primary 48 hours postoperatively. The 2 teams additionally required related complete opioid doses (morphine milligram equivalents) for ache reduction. Liposomal bupivacaine is marketed as a substitute for scale back the necessity for postoperative opioids. 

‘Value questioning’ liposomal bupivacaine in geriatric hip fracture  

In each teams, time to ambulation was about someday and time to hospital discharge was about 4 days. Delirium and different postoperative hostile occasions have been comparable as properly. 

The brand new research – the primary randomized managed trial of liposomal bupivacaine for hip fracture surgical procedure in aged sufferers – confirmed no vital distinction in ache scores and different related outcomes, as in contrast with commonplace intraoperative bupivacaine administration. 

The researchers level out some limitations of their research, together with potential variations in injection approach. Dr. Ng notes: “Our research particularly targeted on hip fractures, and doesn’t contradict the rising physique of proof that liposomal bupivacaine is certainly helpful to scale back ache scores in context of major complete joint arthroplasty.” 

Citing a earlier report, the authors word the excessive price of liposomal bupivacaine: 11 instances greater than commonplace bupivacaine or different postoperative ache modalities. “Given the elevated prices related to liposomal bupivacaine, it’s price questioning its use within the setting of geriatric sufferers with a hip fracture present process hemiarthroplasty,” Dr. Ng and coauthors conclude.