Table 1 Overview of studies analyzed in this study with study characteristics and conclusions
From: The use of liposomal bupivacaine in fracture surgery: a review
Study | Population | Study Type | Intervention/Groups | Pain Score | Narcotic Consumption | Length of Stay | Adverse Events | Study Conclusion | Pacira Pharmaceutical sponsorship | Level of Evidence |
|---|---|---|---|---|---|---|---|---|---|---|
Alter [37] | Distal radius fracture repair | Prospective, single-blinded, randomized clinical trial | Bupivacaine group: 20 mL 0.5% bupivacaine without epinephrine into incision and surgical site (n = 21) Liposomal bupivacaine group: 10 mL 0.5% Bupivacaine without epinephrine into incision and surgical site, 10 mL liposomal bupivacaine into same site (n = 20) | Lower pain score on day of surgery No difference on postoperative days 1–5 | Fewer opioid pills consumed and oral morphine equivalents on day of surgery No difference on postoperative days 1–5 No difference in total opioid pill consumption | NR | 4 of 21 in Bupivacaine group (all minor) 1 of 20 in Liposomal bupivacaine group (minor) | In the liposomal bupivacaine group there was decreased pain and opioid consumption only on the day of surgery and not thereafter | Yes | 1b |
Davidovitch [38] | Ankle fractures (OTA/AO 44A-C) requiring ORIF | Prospective, single-blinded, randomized controlled trial | Control: local sterile saline injection (40 mL normal saline) (n = 39) Interventional: local liposomal bupivacaine (40 mL 1:1 of 1.3% liposomal bupivacaine and sterile saline) (n = 37) | Significantly lower in interventional group versus control at each time point assessed (4, 24, 48, 72, and 336 h postoperatively) | Oxycodone-aceteminophen ingestion at 4 h was less in interventional group At 48 h, the interventional group had less oxycodone-acetaminophen ingestion compared to control; however, this approached but did not reach level of statistical significance No statistically significant difference in total oxycodone-acetaminophen use over postoperative days 1–3 | No difference | None | Local use of liposomal bupivacaine for ankle fractures requiring ORIF affords improved pain relief in the immediate postoperative period, resulting in a reduction in oxycodone-acetaminophen ingestion, with resultant effects seen up to 2 days postoperatively | Yes | 1b |
Hutchinson [39] | Periarticular femoral neck fractures treated with hemiarthoplasty | Retrospective review | Control: no local infiltration (n = 78) LBUP: periarticular injection of liposomal bupivacaine within a multimodal pain management program (n = 100) | No difference postoperative days 1–4 between control and LBUP groups | No difference in total morphine equivalents between control and LBUP groups | Significantly less in LBUP vs. control (4.8 days vs. 5.7 days) | No difference between control and LBUP groups | Supports use of local liposomal bupivacaine as part of multimodal program after hemiarthoplasty for femoral neck fractures | Yes | 4 |
Chen [40] | Distal radius fracture with volar plating | Prospective, intervention based on surgeon preference | Control: supraclavicular nerve block alone (n = 20) Interventional: supraclavicular nerve block with liposomal bupivacaine (n = 26) | No difference in visual analog scale or QuickDASH scores between control and interventional groups at 18, 72, 168, and 336 h postoperatively | NR | NR | NR | No significant rebound pain was observed after the supraclavicular nerve block wore off following volar plating Liposomal bupivacaine did not provide measurable benefit in pain scores in patients who received a supraclavicular nerve block | No | 2b |
Hutchinson [41] | Fractured clavicle; subtrochanteric nonunion s/p cephalomedullary nail | Case series | 20 mL liposomal bupivacaine diluted to 60 mL total volume with normal saline into platysma, pectoralis, trapezius, and deltoid at a depth of 2–3 cm using a 22 g spinal needle, additional 30 mL of 0.25% bupivacaine w/epinephrine 20 mL liposomal bupivacaine diluted to 100 mL total volume with normal saline into quadriceps, 75% anterior subfascial tissue, 25% posteriorly, additional 50 mL of 0.25% bupivacaine w/ epinephrine | NR | “occasional oral opioid” NR | NR | NR | Both patients experienced good control of postsurgical pain, supporting the clinical utility of liposomal bupivacaine in orthopedic trauma surgery | Yes | 4 |
Herbst [42] | Talar neck fracture-dislocation with an open injury, dislocated subtalar joint, avascular talus, and considerable deformity | Case report | One vial (20 mL) of liposomal bupivacaine was mixed with 20 mL of 0.25% bupivacaine, without epinephrine and infiltrated into areas of the deep soft tissue in the peri-ankle area | At 30 h after surgery, patient reported a pain level of 0 (0–10) | NR | NR | NR | Liposomal bupivacaine use in complex foot and ankle surgery may be helpful in maintaining postoperative analgesic activity for up to 72 h | Yes | 5 |
Amin [43] | Extracapsular and intracapsular hip fractures | Expert Panel Opinion—4 orthopedic surgeons and 3 anesthesiologists | NA | NA | NA | NA | NA | Liposomal bupivacaine should be included as part of multimodal strategies Recommend preoperative treatment with acetaminophen, NSAID, and tramadol Presurgical fascia iliaca block with bupivacaine HCl may help bridge before liposomal bupivacaine takes effect | Yes | 5 |
Langworthy [44] | Isolated acetabular fractures | Discussion of best practices between 2 traumatologists and recommendations | NA | NA | NA | NA | NA | Liposomal bupivacaine (266 mg/20 mL) should be expanded with 50 mL of bupivacaine HCl 0.25% and saline to a total volume of 120 or 300 mL for posterior and anterior techniques, respectively 1 dose IV acetaminophen also recommended Patients also receive acetaminophen, celecoxib, gabapentin, and opioids before surgery | Yes | 5 |