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Fascia iliaca blockade with the addition of liposomal bupivacaine vs. plain bupivacaine for perioperative pain management following hip arthroscopy

  • Hip
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

A newer formulation of bupivacaine, encapsulated within carrier molecules, has garnered attention for its role in providing extended post-operative analgesia. The purpose was to evaluate the addition of liposomal bupivacaine to fascia iliaca blockade during hip arthroscopy.

Methods

Retrospective cohort study of patients undergoing hip arthroscopy with a pre-operative fascia iliaca blockade with either liposomal bupivacaine (Group 1; 266mg + 20 cc 0.5% plain bupivacaine) or bupivacaine (Group 2; 40 cc 0.25% plain bupivacaine). All patients received standardized pre-operative oral pain medications. The primary outcome was the defense veteran pain rating scale (DVPRS). Secondary outcomes included duration of hospital admission, PACU opioid use, PACU pain scores, and duration of nerve blockade.

Results

Thirty-eight males and 30 females, mean age of 33 years (range 14–56). There was no difference in pre-operative DVPRS between the groups (n.s.). There was no difference in post-operative DVPRS pain scores at POD0 (3.7 vs. 3.9, n.s.), POD1 (4.2 vs. 3.8, n.s.), POD2 (4.2 vs. 3.7, n.s.), POD3 (3.9 vs. 3.7, n.s.) or POD14 (2.2 vs. 2.4, n.s.). Group 1 trended towards longer mean total hospital admission time (872 vs. 822 min, n.s.), and greater mean morphine equivalents administered in the PACU (33 vs. 29 mg, n.s.). 68% of patients in group 1 reported continued anterior thigh numbness at POD3, compared to 34% in group 2 (p = 0.008).

Conclusions

Despite the advertised benefits of prolonged post-operative analgesia using liposomal bupivacaine, there were no significant differences in post-operative pain scores or PACU opioid consumption. Our results support that acceptable pain scores are successfully achieved at all time periods with the use of multimodal analgesia including fascia iliaca blockade despite the type of pain medication administered.

Level of evidence

III.

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Authors and Affiliations

  1. Department of Orthopaedics, Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD, 20889, USA

    Richard L. Purcell, Kyle E. Nappo, Daniel W. Griffin & Michael Kent

  2. APEX Orthopedic and Sports Medicine Overland Park, Overland Park, KS, USA

    Michael McCabe

  3. Department of Orthopedic Surgery, University of Texas Health Science Center at Houston, Houston, TX, USA

    Terrence Anderson

Authors
  1. Richard L. Purcell
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  2. Kyle E. Nappo
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  3. Daniel W. Griffin
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  4. Michael McCabe
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  5. Terrence Anderson
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  6. Michael Kent
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Contributions

RP and DG were responsible for data collection and analysis. RP, KN and DG all participated in manuscript preparation and MM, TA, MK aided in final editing and proofs.

Corresponding author

Correspondence to Richard L. Purcell.

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Conflict of interest

Neither Richard Purcell, Kyle Nappo, Daniel Griffin, Michael McCabe, Terrence Anderson or Michael Kent have any financial disclosures or conflicts of interest to report.

Ethical approval

This study was appoved by our institution’s ethical review commitee in conjunction with the institutional review board approval.

Informed consent

For this type of study, formal consent was not required.

Additional information

The views expressed in this manuscript are those of the authors and do not reflect the official policy of the Department of Army, Department of Defense, or US Government. Three authors are employees of the United States government. This work was prepared as part of their official duties and as such, there is no copyright to be transferred.

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Purcell, R.L., Nappo, K.E., Griffin, D.W. et al. Fascia iliaca blockade with the addition of liposomal bupivacaine vs. plain bupivacaine for perioperative pain management following hip arthroscopy. Knee Surg Sports Traumatol Arthrosc 26, 2536–2541 (2018). https://doi.org/10.1007/s00167-018-4874-x

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  • DOI: https://doi.org/10.1007/s00167-018-4874-x

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