Liposomal Bupivacaine Doesn’t Decrease Pain After Hip Fracture Surgery, Study Finds
Researchers from Maimonides Medical Center in Brooklyn, New York, report that compared with conventional bupivacaine, intraoperative use of liposomal bupivacaine does not improve pain scores or other relevant outcomes, such as function and length of hospital stay, among older adults undergoing hemiarthroplasty for hip fracture.
The study was published online ahead of print by The Journal of Bone & Joint Surgery.
Liposomal bupivacaine is a long-acting local anesthetic developed for use in relieving postoperative pain, allowing drug release over up to 72 hours. Studies have shown that liposomal bupivacaine can reduce pain after various surgical procedures, including total knee or total hip arthroplasty. Few studies have assessed its use following hip fracture surgery.
The researchers enrolled in study 50 older adults who were undergoing hip hemiarthroplasty for isolated intracapsular femoral neck fracture and then randomly assigned them to intraoperative injection of either liposomal bupivacaine or standard bupivacaine hydrochloride. In both groups, a series of injections were made around the reconstructed joint toward the end of the procedure.
Pain scores, total opioid dose, and time to ambulate were assessed in blinded fashion. Time to hospital discharge, safety, and a range of secondary outcomes were evaluated as well.
The results showed no significant difference in pain scores for liposomal bupivacaine and standard bupivacaine (2.3 vs 2.7, respectively), with scores remaining comparable throughout the first 48 hours postoperatively. The 2 groups also required similar total opioid doses (morphine milligram equivalents) for pain relief. Liposomal bupivacaine is marketed as an alternative to reduce the need for postoperative opioids.
In both groups, time to ambulation was about 1 day and time to hospital discharge was about 4 days. Delirium and other postoperative adverse events were comparable as well.
The new study – the first randomized controlled trial of liposomal bupivacaine for hip fracture surgery in elderly patients – showed no significant difference in pain scores and other relevant outcomes, as compared with standard intraoperative bupivacaine administration.
The researchers point out some limitations of their study, including possible variations in injection technique. They said that their study “specifically focused on hip fractures, and does not contradict the growing body of evidence that liposomal bupivacaine is indeed beneficial to reduce pain scores in context of primary total joint arthroplasty.”
Citing a previous report, the authors note the high cost of liposomal bupivacaine: 11 times higher than standard bupivacaine or other postoperative pain modalities. “Given the increased costs associated with liposomal bupivacaine, it is worth questioning its use in the setting of geriatric patients with a hip fracture undergoing hemiarthroplasty,” the study authors concluded.
Source
Kang KK, Voyvodic L, Komlos D, Swigggertt S, Ng MK. Liposomal bupivacaine does not decrease postoperative pain in patients with intracapsular femoral neck fracture treated with hemiarthroplasty: HEAT-a randomized, controlled trial. J Bone Joint Surg Am. 2024 Sep 18. doi: 10.2106/JBJS.23.01344. Online ahead of print.