Dr. Stickney, a Kirkland orthopedic surgeon, is a knee expert specializing in new knee surgery procedures, total knee replacement, sports medicine, and more.
Managing postsurgical pain after total knee arthroplasty (TKA) is critical to successful surgical outcomes including patient recovery, rehabilitation and overall satisfaction. Local infiltration analgesia (LIA) with anesthetic agents is shown to improve pain and reduce morphine consumption. It also shortens the length of hospital stays compared with using peripheral nerve blocks, which can hinder mobility. A randomized control PILLAR study conducted by Michael A. Mont, M.D., Walter B. Beaver, M.D., Stanley H. Dysart, M.D., John W. Barrington, M.D., and Daniel J. Gaizo, M.D. took a closer look at the efficacy of LIA with Liposomal Bupivacaine (LB) in improving patient pain scores and reducing opioid use after TKA.
Here, the study team compared the effects of LIA with or without LB on pain scores, opioid consumption including opioid-free patients, time to first opioid rescue, and safety after primary unilateral total knee arthroplasty.
The study involved 140 TKA patients randomized to LIA with LB to 266mg/20mL (admixed with bupivacaine HCI %0.5, 20mL) or LIA with Bupivacaine HCI %0.5, 20mL. Standardized infiltration techniques and standardized multimodal pain protocol were used. Co-primary efficacy endpoints were the area under the curve (AUC) visual analog scale pain intensity scores 12-48 hours post-surgery, and total opioid consumption 0-48 hours post-surgery.
Findings were notable. AUC 12-48 post-surgical visual analog pain intensity scores were 180.8 with LB, and 209.3 without the use of LB. Total opioid consumption 0-48 hours post-surgery was 18.7mg with and 84.9 without LB. Significant differences favoring LB were observed for the percentage of opioid-free patients (p<.01) and time to first opioid rescue (P=.0230). In the TKA setting, LIA with LB administered with optimal techniques significantly improved post-surgical pain, opioid use and time to first opioid rescue, with more opioid free patients and no unexpected safety concerns.
My past TKA patients will tell you the SwiftPath protocols I utilize are well aligned to this study. With a reduction in (or no) opioids after TKA, less post-operative pain and overall patient satisfaction, the use of LIA with LB is well-supported.
If you are a total knee arthroplasty candidate and want to learn more about treatments such as LIA with LB, please contact our office. We’ll help you return to your healthy, pain-free lifestyle.