(1) Intraoperative liposomal bupivacaine is associated with improved pain, opioid use, functional, and length of stay outcomes after total knee arthroplasty: real-world evidence

Background: : Optimized perioperative pain control for total knee arthroplasty (TKA) is imperative to facilitate early discharge and enhanced outcomes. There is an unmet need for real-world data on pain, opioid, and recovery outcomes with liposomal bupivacaine (LB), a long-acting local anesthetic (LA) that can extend postoperative analgesia. The Innovations in Genicular Outcomes Registry (IGOR) is a prospective, observational registry in which clinical decision-making is performed by treating physicians and their patients, with standardized collection of real-world data, including clinical, patient-reported, reimbursement, and healthcare resource utilization outcomes.

Objective: : To evaluate the real-world effectiveness of LB versus conventional LAs in patients undergoing primary TKA.

Methods: : Data were collected from IGOR for opioid-naive patients who underwent unilateral primary TKA between September 2021 and December 2024. Patients were stratified based on intraoperative analgesia (LB vs conventional LAs [bupivacaine or ropivacaine]). The Brief Pain Inventory-Short Form (BPI-SF) was used to assess patients’ pain. Opioid use was evaluated by analgesic questionnaire. Functional outcomes were measured with the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement. Length of stay (LOS; hours from facility admission to discharge) was also recorded. Comparative analyses of longitudinal outcomes were performed with multivariable generalized linear mixed-effects models with varied distributions; LOS was compared via multivariable negative binomial regression modeling.

Results: : Overall, 225 patients were included (LB, n=42; conventional LAs, n=183). Patients receiving LB demonstrated lower average BPI-SF scores than those with conventional LAs in the first 5 days (3.9 vs 4.9; P< 0.001) and subsequent 3 months (2.6 vs 2.9; P=0.03) after TKA. The proportion of patients with opioid use over 3 months was also ~3-fold lower in the LB cohort (29% vs 83%; P< 0.001). Patients receiving LB had improved physical function from baseline compared to those in the conventional LAs cohort (1.5 vs 1.0 standard deviation improvement; P< 0.001). Patients who received LB were also discharged significantly earlier (15.0 vs 20.6 hours; P=0.007).

Conclusions: : Intra/postoperative LB is associated with improved pain control and functional outcomes as well as reduced opioid use after TKA compared with conventional LAs. The reduction in LOS with LB is especially relevant in ambulatory surgery rapid recovery protocols.

Sponsorship:: Pacira BioSciences, Inc.