UK Study Questions Liposomal Bupivacaine Efficacy for TKA

A new systematic review of the literature from the UK has concluded that sustained release liposomal bupivacaine does not deliver better pain relief than simple bupivacaine hydrochloride for patients undergoing total knee replacement.

The study, “Efficacy of Liposomal Bupivacaine and Bupivacaine Hydrochloride vs Bupivacaine Hydrochloride Alone as a Periarticular Anesthetic for Patients Undergoing Knee Replacement,” appears in the April 6, 2022, edition of JAMA Surgery.

Co-author Thomas Hamilton, with the Oxford Orthopaedic Engineering Centre, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences at the University of Oxford in the UK, explained the genesis of the study to OTW: “Huge progress has been made in the management of post-operative pain over the last two decades. However, despite this, qualitative research we conducted has identified that pain remains a major concern for patients and pain appears to be associated with excess morbidity and mortality and may be associated with long term outcomes.”

“Furthermore, pain remains the primary reason patients remain in hospital following surgery, as well as a common reason for re-admission following surgery.”

“Liposomal bupivacaine, a novel sustained release local anaesthetic, represented an opportunity to further improve post-operative pain and deliver benefits to patients, healthcare professional as well as health care payers.”

After performing a Cochrane Systematic Review of the literature, the research team concluded that the limited evidence available did not demonstrate superiority for using liposomal bupivacaine at the surgical site as compared to bupivacaine hydrochloride.

“We identified that there was the need for a high quality, adequately powered, randomised controlled trial,” said Hamilton.

After concluding their systematic review, Dr. Hamilton summarized the results to OTW, “Among the 533 participants included in the analysis there was no difference in the Quality of Recovery 40 (QoR-40) score at 72 hours, nor the pain Visual Analogue Score area under the curve, 6 to 72 hours, between the liposomal bupivacaine and the bupivacaine hydrochloride groups.”

“Analyses of pain Visual Analogue Score and QoR-40 scores demonstrated only one statistically significant difference, with the liposomal bupivacaine arm having lower pain scores the evening of surgery however this difference was not considered of a clinically relevant magnitude, nor at a clinically relevant timepoint with respect to the mechanism of action of liposomal bupivacaine. No difference in cumulative opioid consumption or functional outcomes was detected. Liposomal bupivacaine was not found to be cost-effective compared with bupivacaine hydrochloride.”

“This study found that liposomal bupivacaine did not improve post-operative recovery or pain compared with bupivacaine hydrochloride alone among patients undergoing knee replacement surgery. The results of this study do not support the routine use of liposomal bupivacaine to improve post-operative recovery and pain following knee replacement.”