A literature review conducted by Alan Dine, senior director of Global Clinical Strategy and Government Affairs at Halyard Health, has found that a continuous infusion of local bupivacaine reduced the need for opioids more than injections of liposomal bupivacaine (EXPAREL, manufactured by Pacira Pharmaceuticals) following total knee arthroplasty (TKA). The continuous infusion came via Halyard’s ON-Q Pain Relief System, a non-narcotic elastomeric pump.
Continuous Bupivacaine Drastically Reduces Opioid Consumption
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Taking into account the four studies available for review, use of the continuous infusion of bupivacaine lowered opioid consumption by 55% in the first 48 hours, and 71% in the first 48-72 hours postoperative—compared to either a single injection of local anesthetic, or liposomal bupivacaine.
Roger Massengale, general manager of Acute Pain at Halyard Health, told OTW, “The results of the study confirm the hypothesis that continuous infusions of local anesthetics would perform better than single injections of standard local or EXPAREL.”
“Research is also warranted to investigate whether continuous infusions for acute post-operative pain may also reduce the incidence of chronic pain resulting from surgery.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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