Liposomal Bupivacaine in Adductor Canal Blocks Before Total Knee Arthroplasty Leads to Improved Post-Operative Outcomes: A Randomized Controlled Trial
Abstract
BACKGROUND
This study compares the use of Liposomal Bupivacaine (Exparel) versus Ropivacaine in adductor canal blocks (ACB) before total knee arthroplasties (TKA).
METHODS
From the months of April 2020 to September 2021, 147 patients undergoing unilateral primary TKA were asked to participate in this prospective double-blinded randomized controlled trial. Each patient received an iPACK block utilizing ropivacaine and was additionally randomized to receive an ACB with Exparel or Ropivacaine. For each patient, demographic information, inpatient hospital information, post-operative opioid use, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire scores were collected.
RESULTS
Overall, 100 patients were included (50 in each cohort). The Exparel group had a lower hospital length of stay compared to the Control group (36.3 vs. 49.7 hours, p<0.01). Patients in the Exparel group reported an increased amount of NRS pain score improvement at all post-operative timepoints. These patients also used a lower amount of inpatient opioids (40.9 vs. 47.3 MME/day, p=0.04) but a similar amount of outpatient opioids (33.4 vs. 32.1 MME/day, p=0.351). Finally, the Exparel group had increased improvements in all WOMAC subscores and total scores at most timepoints compared to the Control group (p<0.05).
CONCLUSION
Exparel peripheral regional nerve blocks lead to decreases in pain levels, shorter hospital lengths of stay, inpatient opioid usage, and improved WOMAC…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 100 participants or records.
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