Efficacy of Liposomal Bupivacaine in Orthopedic Procedures in an Academic Trauma Hospital

Background: Alternatives to opioids have been sought to control postoperative pain given the opioid epidemic. Liposomal bupivacaine has been suggested to decrease postoperative opioid use and pain scores. The purpose of this study was to discover the effect of liposomal bupivacaine on postoperative pain scores and narcotic usage in orthopedic patients.Methods: A retrospective cohort study of adult orthopedic patients was performed comparing those who received liposomal bupivacaine intraoperatively to those that received standard of care between January 2014 and December 2014. A least-squares regression model, was used to adjust for the influence of  signifi cant variables on primary outcomes; opioid use and pain scores.Findings: The study enrolled 460 patients with an average age of 58 years and median Charlson Comorbidity Index of 3. Least squares regression analysis found a decrease in cumulative morphine equivalents used in postoperative patients that received liposomal bupivacaine at all pre-defined time points up to 48 hours postoperatively. At 48 hours the standard of care patients received 19mg of morphine equivalents more than the liposomal bupivacaine group. Pain scores were comparable between those who received standard of care and those that received liposomal bupivacaine, however a statistically significant decrease in pain scores was noted in those that received liposomal bupivacaine at 1 hours, 6 hours, and 12 hours.Conclusion: A statistically signifi cant decrease in opioid consumption was found up to 48 hourspostoperatively with use of liposomal bupivacaine. Given the small decrease in morphine equivalents,this may not be clinically significant.