Intraoperative Infiltration of Liposomal Bupivacaine vs. Bupivacaine HCL for Pain Management in Primary Total Hip Arthroplasty - A Prospective Randomized Trial

Introduction: Pain management after Total Hip Arthroplasty (THA) is well studied. Nevertheless, there is no consensus regarding the “cocktail” to use in peri-articular infiltration (PAI). Liposomal bupivacaine (LB) is a slow release local anesthetic that can be infiltrated during surgery. In this study we compared LB to bupivacaine HCL

Methods: Between September 2014 and March 2016, one-hundred and seven patients were enrolled in this prospective randomized trial. Patients were separated into LB and Control groups. LB group (43) received PAI with LB and bupivacaine HCl with epinephrine and the Control group (48) received PAI with bupivacaine HCL and epinephrine. Patient morphine equivalent consumption, pain score estimated on visual analog scale, time to first ambulation greater than 20 feet, time to discharge, drug-related side effects and patient falls were documented. Data was collected up to 72 hours post-operation.

Results: The LB group had significantly reduced morphine equivalent consumption in the first 12 hours following the primary anterior approach THA. There was no significant difference in morphine equivalent consumption in the following 12 hour time blocks, up to 72 hours. No patient falls were documented in either group. Time to first ambulation greater than 20 feet, ambulation same day as surgery, time to discharge and drug-related side effects were not significantly different between groups.

Conclusions: Intra-operative PAI with LB resulted in a statistically significant reduction in opioid consumption compared to bupivacaine HCL in patients undergoing anterior approach primary THA in the first 12 hours. There were no other differences between the groups.