New Study: Liposomal Bupivacaine Reduces Opioid Use

A new study by the Orthopaedic and Neurosurgery Specialists Foundation for Clinical Research and Education (ONSF) found that administration of liposomal bupivacaine after rotator cuff repair reduced opioid consumption by 64%.

The research was presented at the October 11 – 14, 2018 American Shoulder and Elbow Surgeons Annual Meeting in Chicago.

The researchers compared a control group of primary arthroscopic rotator cuff repair patients who were given an interscalene block (ISB) with bupivacaine 0.5% to a second group of primary arthroscopic rotator cuff repair patients who received the same ISB but also a field block with 20 mL of liposomal bupivacaine expanded with 40 mL saline to a total volume of 60 mL.

Patients’ pain scores and postoperative opioid consumption were measured and according to the data collected the patients who received liposomal bupivacaine reported statistically and clinically lower pain scores on postoperative days 1 and 2 as well as lower overall pain for the procedure.

Patients reported scores of 2.6 vs 5.7 for control group patients on Postoperative Day 1, p= 0.001 and scores of 3.6 vs 5.0 for control group patients on Postoperative Day 2, p= 0.05.

The liposomal bupivacaine patients also consumed 64% fewer opioids (consuming 73.8 ± 51.9 oral morphine equivalents [OME] vs a consumption of 203.3 ± 127.7 OME in the control group; p= 0.005). They also stopped taking opioids more quickly and did not request a refill of their opioid prescription.

“These study results clearly suggest that the addition of a liposomal bupivacaine field block to a bupivacaine interscalene nerve block for rotator cuff repair makes a significant difference in decreasing the level of pain patients experience following surgery, and thus the number of opioids they need to manage pain during their recovery period,” said Paul M. Sethi, M.D, lead researcher and president of the ONS Foundation for Clinical Research and Education.

“High opioid prescribing and overprescribing for postsurgical pain carries not only acute risks related to opioid‐related adverse effects, but alsothe risk oflong-termopioid use. Through greater use of multimodal, opioid‐minimizing pain management strategies, there is an opportunity to keep patients safe from these dangers.”

“Our findings suggest that arthroscopic rotator cuff repair patients treated with liposomal bupivacaine along with an interscalene nerve block should be prescribed no more than 25 oxycodone 5 mg pills—a stark contrast to the current average amounts prescribed, which a recent report – Exposing a Silent Gateway to Persistent Opioid Use– found to be about 93 pills,” Sethi added.

“This meaningful reduction in volume of pills prescribed not only helps reduce the risk of opioid addiction or dependence in postsurgical patients, but also the quantity of unused pills in the home, which are often improperly disposed of or stored.”