Liposomal bupivacaine reduces opioid consumption and length of stay in patients undergoing primary total hip arthroplasty

Optimising postoperative pain management after total hip arthroplasty (THA) has been associated with improved patient outcomes. However, conclusions regarding the role of liposomal bupivacaine (LB) during THA remain mixed. The purpose of this study was to determine whether substituting a standard intraoperative wound infiltrate with LB as part of a multimodal pain management protocol would decrease subsequent opioid consumption and overall length of hospital stay in patients undergoing primary THA.

Data was retrospectively collected on 170 consecutive patients who underwent primary THA at a single institution from January 2014 to October 2014. Outcomes from the first 85 patients who received intraoperative LB were compared to the prior 85 patients who received a standard intraoperative “cocktail” without LB. The remainder of the multimodal pain management protocol was identical between groups.

Total continuous and categorical postoperative hospital opioid consumption rates in the LB subgroup were significantly lower than the non-LB subgroup (p < 0.001). The use of LB was associated with a relative reduction in opioid consumption on the day of surgery (p = 0.001), postoperative day 1 (p < 0.001), postoperative day 2 (p < 0.001) and postoperative day 3 (p < 0.001). Patients who received LB had decreased length of stay (p = 0.001) and were discharged on lower doses of opioids.

Substituting to LB from a standard wound infiltrate during primary THA, in addition to our standard multimodal pain management protocol, resulted in significantly lower postoperative opioid consumption and decreased length of stay.