In the Journals

Lumbar plexus nerve block, liposomal bupivacaine led to modest improvement for opioid use after THA

Patients who received either posterior lumbar plexus nerve block or periarticular infiltration with liposomal bupivacaine during total hip arthroplasty experienced a modest improvement with respect to analgesia and opioid consumption compared with patients who received periarticular infiltration with ropivacaine, according to results.

“While the more complex lumbar plexus block delivered slightly better pain relief, all three strategies provided good pain relief and required relatively little supplemental use — useful information in the context of today’s opioid epidemic,” Mark W. Pagnano, MD, told Healio.com/Orthopedics.

Pagnano and colleagues randomly assigned 159 patients undergoing THA to receive posterior lumbar plexus block (PNB; n=51), periarticular infiltration with ropivacaine, ketorolac and epinephrine (PAI-R; n=54) or periarticular infiltration with liposomal bupivacaine, ketorolac and epinephrine (PAI-L; n=54). Researchers measured maximum pain during the morning of the first postoperative day on an ascending numeric rating scale from 0 to 10 for the primary outcome.

On the morning of the first postoperative day, results showed patients had no significant differences with respect to the primary end point. Researchers found all patients had low consumption of opioids and consumption did not differ across groups at any intervals. According to results, patients in the PAI-L group had a lower median maximum pain on postoperative day 1 of 4 vs. 5 in the PNB group and 5.5 in the PAI-R group. Researchers found patients in the PNB group and the PAI-L group had lower maximum pain on postoperative day 2 vs. the PAI-R group. Patients in the PNB group and PAI-L group also had no significant difference when it came to postoperative opioid use including rescue IV opioid medication, length of stay and hospital adverse events, and 3-month follow-up data including any complication. – by Casey Tingle

Disclosures: Pagnano reports he receives other support from Stryker and Pixar Bio and personal fees from Pacira. Please see the full study for a list of all other authors relevant financial disclosures.

Patients who received either posterior lumbar plexus nerve block or periarticular infiltration with liposomal bupivacaine during total hip arthroplasty experienced a modest improvement with respect to analgesia and opioid consumption compared with patients who received periarticular infiltration with ropivacaine, according to results.

“While the more complex lumbar plexus block delivered slightly better pain relief, all three strategies provided good pain relief and required relatively little supplemental use — useful information in the context of today’s opioid epidemic,” Mark W. Pagnano, MD, told Healio.com/Orthopedics.

Pagnano and colleagues randomly assigned 159 patients undergoing THA to receive posterior lumbar plexus block (PNB; n=51), periarticular infiltration with ropivacaine, ketorolac and epinephrine (PAI-R; n=54) or periarticular infiltration with liposomal bupivacaine, ketorolac and epinephrine (PAI-L; n=54). Researchers measured maximum pain during the morning of the first postoperative day on an ascending numeric rating scale from 0 to 10 for the primary outcome.

On the morning of the first postoperative day, results showed patients had no significant differences with respect to the primary end point. Researchers found all patients had low consumption of opioids and consumption did not differ across groups at any intervals. According to results, patients in the PAI-L group had a lower median maximum pain on postoperative day 1 of 4 vs. 5 in the PNB group and 5.5 in the PAI-R group. Researchers found patients in the PNB group and the PAI-L group had lower maximum pain on postoperative day 2 vs. the PAI-R group. Patients in the PNB group and PAI-L group also had no significant difference when it came to postoperative opioid use including rescue IV opioid medication, length of stay and hospital adverse events, and 3-month follow-up data including any complication. – by Casey Tingle

Disclosures: Pagnano reports he receives other support from Stryker and Pixar Bio and personal fees from Pacira. Please see the full study for a list of all other authors relevant financial disclosures.