Published results showed use of plain bupivacaine had no significant differences in postoperative pain scores and narcotic pill usage after hip arthroscopy compared with liposomal bupivacaine administered via a fascia iliaca blockade.
Researchers randomly assigned 70 patients undergoing hip arthroscopy to receive a fascia iliaca blockade with 40 mL of 0.25% plain bupivacaine (n=37; control group) or 20 mL of 0.5% plain bupivacaine plus 20 mL liposomal bupivacaine (n=33; study group). Researchers collected Defense and Veterans Pain Rating Scale scores in the post-anesthesia care unit and on postoperative days 1, 2, 3 and 14, as well as postoperative opioid consumption and subjective loss of anterior thigh sensation.
Results showed no significant differences in postoperative Defense and Veterans Pain Rating Scale scores between the two groups at any time point. Researchers also found no significant differences in total postoperative opioid use during any postoperative time points. Although most patients in both groups reported loss of normal anterior thigh sensation prior to hospital discharge, researchers noted a continued loss of normal anterior thigh sensation in 97% of patients who received liposomal bupivacaine vs. 51.4% of patients who received plain bupivacaine 48 hours postoperatively. Thigh numbness at 72 hours postoperatively was reported by 81.2% of patients who received liposomal bupivacaine compared with 21.6% of patients who received plain bupivacaine, according to results.
“Given the highly significant findings of prolonged anterior thigh numbness out to [postoperative day 3] POD3 in patients who received liposomal bupivacaine, this formulation did exhibit prolonged effects; however, it did not provide improved pain control when used in this surgical population, likely due to the innervation of the hip capsule from differential nerve plexi,” the authors wrote. “Given the six-fold increased cost of using the liposomal formulation, we are unable to recommend its use via a fascia iliaca blockade for hip arthroscopy.” – by Casey Tingle
Disclosures: The authors report no relevant financial disclosures.