Liposomal Bupivacaine Infiltration Reduced Costs and Opioid Use in TKA Surgery Interview with:
Bryan Sakamoto MD, PhD
Department of Anesthesia
Richard L. Roudebush, Veterans Affairs Medical Center
Department of Anesthesia
Indiana University School of Medicine
Indianapolis, Indiana What is the background for this study?

Response: Liposomal bupivacaine is a novel extended-duration anesthetic that has recently become a popular option in total knee arthroplasty (TKA) for post-operative pain management. Although liposomal bupivacaine is widely used, it is unknown if the benefits justify the cost in the veteran population at our institution. The main purpose of this medication use study was to evaluate the cost verses benefit of using this agent in our veteran patient population. What are the main findings?

Response: In this drug utilization evaluation, patients undergoing TKA with liposomal bupivacaine had a reduced median use of opioids in the initial 24 hours after surgery. In addition, a reduction in the use of patient-controlled analgesia (PCA) and anti-emetics in the initial 24 hours after surgery was observed. An institutional cost savings was estimated at $27,000 per/year. What should readers take away from your report?

Response: We have shown a decrease in opioid use in the initial 24 hours after undergoing TKA with liposomal bupivacaine. Because opioids are associated with adverse events, this reduction in narcotic consumption may also result in a concomitant reduction in untoward patient outcomes and an increase in overall patient satisfaction.

In addition to the cost of liposomal bupivacaine, the total cost of PCA and etCO2 equipment (including cost to set up equipment) needs to be considered. By reducing PCA usage by almost 50%, we were able to show an estimated institutional cost savings of $27,000 per /year.

Finally, the results of this study suggest that liposomal bupivacaine is effective as part of a multimodal pain regimens for TKA in the veteran population. What recommendations do you have for future research as a result of this study?

Response: Are the benefits of liposomal bupivacaine observed in other surgical procedures in the veteran population? Is there anything else you would like to add?

Response: To our knowledge, this is the first study to evaluate the use of liposomal bupivacaine in the Veteran’s Affairs medical system. Thank you for your contribution to the community.

Efficacy of Liposomal Bupivacaine Infiltration on the Management of Total Knee Arthroplasty
Bryan Sakamoto, MD, PhD; Shelly Keiser, PharmD; Russell Meldrum, MD; et al.
JAMA Surg. Published online October 12, 2016. doi:10.1001/jamasurg.2016.3474

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on October 18, 2016 by Marie Benz MD FAAD