Observation of analgesic efficacy of liposomal bupivacaine for local infiltration anesthesia in unicompartmental knee arthroplasty: a prospective randomized controlled study_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHENG Shanbin ¹ , HU Hongyu ² , XIA Tianwei ¹ , SHAO Liansheng ¹ , ZHU Jiaqing ¹ , SUN Jiahao ¹ , MA Bowen ¹ , ZHANG Chiyu ¹ , HUANG Libing ² , CAO Xun ¹ , CHEN Zhiyuan ¹ , ZHANG Chao ¹ ,  SHEN Jirong ¹

1. Department of Orthopedics, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing Jiangsu, 210029, P. R. China;
2. Department of Anesthesiology, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing Jiangsu, 210029, P. R. China;

Corresponding?author：

SHEN Jirong, Email: joint66118@sina.com

Keywords：

Unicompartmental knee arthroplasty; liposomal bupivacaine; “cocktail” therapy; local infiltration anesthesia; analgesic effectiveness; randomized controlled study

DOI：

10.7507/1002-1892.202408085

Video：

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Objective A prospective randomized controlled study was conducted to investigate the early postoperative analgesic effectiveness of using liposomal bupivacaine (LB) for local infiltration anesthesia (LIA) in unicompartmental knee arthroplasty (UKA). Methods Between January 2024 and July 2024, a total of 80 patients with knee osteoarthritis (KOA) who met the selection criteria were enrolled in the study. Patients were randomly assigned to either the LB group or the “cocktail” group in a 1∶1 ratio using a random number table, with 40 patients in each group. Baseline characteristics, including gender, age, body mass index, operated side, Kellgren-Lawrence grade, and preoperative American Society of Anesthesiologists (ASA) classification, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and knee joint range of motion, showed no significant difference between the two groups (P>0.05). Both groups received LIA and comprehensive pain management. The surgical duration, incision length, pain-related indicators [resting and activity visual analogue scale (VAS) scores, total dosage of oral morphine, WOMAC scores], knee joint range of motion, first ambulation time after operation, length of hospital stay, and postoperative adverse events. Results There was no significant difference between the two groups in surgical duration, incision length, first ambulation time after operation, length of hospital stay, total dosage of oral morphine, and pre-discharge satisfaction with surgery and WOMAC scores (P>0.05). At 4, 12, and 24 hours after operation, the resting and activity VAS scores in the “cocktail” group were lower than those in the LB group; at 60 and 72 hours postoperatively, the resting VAS scores in the LB group were lower than those in the “cocktail” group, with the activity VAS scores also being lower at 60 hours; all showing significant differences (P<0.05). There was no significant difference in the above indicators between the two groups at other time points (P>0.05). On the second postoperative day, the sleep scores of the LB group were significantly higher than those of the “cocktail” group (P<0.05), while there was no significant difference in sleep scores on the day of surgery and the first postoperative day (P>0.05). Additionally, the incidence of complications showed no significant difference between the two groups (P>0.05). Conclusion The use of LB for LIA in UKA can provide prolonged postoperative pain relief; however, it does not demonstrate a significant advantage over the “cocktail” method in terms of short-term analgesic effects or reducing opioid consumption and early functional recovery after UKA. Nevertheless, LB may help reduce postoperative sleep disturbances, making it a recommended option for UKA patients with cardiovascular diseases and insomnia or other mental health issues.

Citation： ZHENG Shanbin, HU Hongyu, XIA Tianwei, SHAO Liansheng, ZHU Jiaqing, SUN Jiahao, MA Bowen, ZHANG Chiyu, HUANG Libing, CAO Xun, CHEN Zhiyuan, ZHANG Chao, SHEN Jirong. Observation of analgesic efficacy of liposomal bupivacaine for local infiltration anesthesia in unicompartmental knee arthroplasty: a prospective randomized controlled study. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(12): 1458-1465. doi: 10.7507/1002-1892.202408085 Copy

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6.	Wylde V, Beswick A, Bruce J, et al. Chronic pain after total knee arthroplasty. EFORT Open Rev, 2018, 3(8): 461-470.
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14.	Schwartz G, Gadsden JC, Gonzales J, et al. A phase 3 active-controlled trial of liposomal bupivacaine via sciatic nerve block in the popliteal fossa after bunionectomy. J Clin Anesth, 2024, 94: 111402. doi: 10.1016/j.jclinane.2024.111402.
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27.	Curtis GB, Johnson GH, Clark P, et al. Relative potency of controlled-release oxycodone and controlled-release morphine in a postoperative pain model. Eur J Clin Pharmacol, 1999, 55(6): 425-429.
28.	Takahashi M, Ohara T, Yamanaka H, et al. The oral-to-intravenous equianalgesic ratio of morphine based on plasma concentrations of morphine and metabolites in advanced cancer patients receiving chronic morphine treatment. Palliat Med, 2003, 17(8): 673-678.
29.	Swarm RA, Paice JA, Anghelescu DL, et al. Adult cancer pain, version 3. 2019, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2019, 17(8): 977-1007.
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32.	Quaye A, McAllister B, Garcia JR, et al. A prospective, randomized trial of liposomal bupivacaine compared to conventional bupivacaine on pain control and postoperative opioid use in adults receiving adductor canal blocks for total knee arthroplasty. Arthroplasty, 2024, 6(1): 6. doi: 10.1186/s42836-023-00226-y.
33.	Bedard NA, DeMik DE, Dowdle SB, et al. Trends and risk factors for prolonged opioid use after unicompartmental knee arthroplasty. Bone Joint J, 2018, 100-B(1 Supple A): 62-67.
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1. Evans JT, Whitehouse MR. Partial versus total knee replacement for knee osteoarthritis. Lancet, 2019, 394(10200): 712-713.
2. 郇瑞, 管士坤, 郭蜀新, 等. 膝關節單髁置換術治療高齡膝骨關節炎患者的研究進展. 中國修復重建外科雜志, 2024, 38(8): 1022-1026.
3. 劉典琦, 黃文彬, 翟文潤, 等. 膝關節單髁置換術中單次與連續收肌管阻滯聯合局部浸潤麻醉前瞻性對比研究. 中國修復重建外科雜志, 2024, 38(4): 448-454.
4. Leiss F, G?tz JS, Maderbacher G, et al. Pain management of unicompartmental (UKA) vs. total knee arthroplasty (TKA) based on a matched pair analysis of 4144 cases. Sci Rep, 2020, 10(1): 17660. doi: 10.1038/s41598-020-74986-x.
5. Gifstad T, Nordskar JJ, Egeberg T, et al. Cementless unicompartmental knee arthroplasty results in higher pain levels compared to the cemented technique: a prospective register study. Knee Surg Sports Traumatol Arthrosc, 2022, 30(8): 2738-2743.
6. Wylde V, Beswick A, Bruce J, et al. Chronic pain after total knee arthroplasty. EFORT Open Rev, 2018, 3(8): 461-470.
7. Bianconi M, Ferraro L, Traina GC, et al. Pharmacokinetics and efficacy of ropivacaine continuous wound instillation after joint replacement surgery. Br J Anaesth, 2003, 91(6): 830-835.
8. 北京醫學會骨科專業委員會關節外科學組, 中華醫學會骨科學分會關節外科學組. 中國全膝關節置換術圍手術期疼痛管理指南(2022). 協和醫學雜志, 2022, 13(6): 965-985.
9. Li Z, Li Z, Cheng K, et al. The efficacy and safety of glucocorticoid on periarticular infiltration analgesia in total knee arthroplasty: A systematic review and meta-analysis of randomized controlled trials. J Arthroplasty, 2021, 36(9): 3340-3350.
10. Gurava Reddy AV, Thayi C, Natarajan N, et al. Validating the role of steroid in analgesic cocktail preparation for local infiltration in total knee arthroplasty: A comparative study. Anesth Essays Res, 2018, 12(4): 903-906.
11. El-Boghdadly K, Short AJ, Gandhi R, et al. Addition of dexamethasone to local infiltration analgesia in elective total knee arthroplasty: double-blind, randomized control trial. Reg Anesth Pain Med, 2021, 46(2): 130-136.
12. 陽強, 王浩洋, 肖強, 等. 新型“雞尾酒”局部浸潤鎮痛在人工全髖關節置換術后的鎮痛效果觀察——一項前瞻性隨機對照研究. 中國修復重建外科雜志, 2022, 36(12): 1485-1491.
13. Sreelaya P, Bhattacharya S. A mini-review based on multivesicular liposomes: Composition, design, preparation, characteristics, and therapeutic importance as DEPOFOAM^? technology. Curr Pharm Biotechnol, 2023, 24(12): 1479-1488.
14. Schwartz G, Gadsden JC, Gonzales J, et al. A phase 3 active-controlled trial of liposomal bupivacaine via sciatic nerve block in the popliteal fossa after bunionectomy. J Clin Anesth, 2024, 94: 111402. doi: 10.1016/j.jclinane.2024.111402.
15. Dengler KL, Craig ER, DiCarlo-Meacham AM, et al. Preoperative pudendal block with liposomal and plain bupivacaine reduces pain associated with posterior colporrhaphy: a double-blinded, randomized controlled trial. Am J Obstet Gynecol, 2021, 225(5): 556. e1-556. e10.
16. Knackstedt R, Gatherwright J, Djohan R. The analgesic effects of liposomal bupivacaine versus bupivacaine hydrochloride administered as a transversus abdominis plane block after abdominally based autologous microvascular breast reconstruction: A prospective, single-blind, randomized, controlled trial. Plast Reconstr Surg, 2020, 145(5): 997e-998e.
17. Turan A, Cohen B, Elsharkawy H, et al. Transversus abdominis plane block with liposomal bupivacaine versus continuous epidural analgesia for major abdominal surgery: The EXPLANE randomized trial. J Clin Anesth, 2022, 77: 110640. doi: 10.1016/j.jclinane.2021.110640.
18. Sakamoto B, Keiser S, Meldrum R, et al. Efficacy of liposomal bupivacaine infiltration on the management of total knee arthroplasty. JAMA Surg, 2017, 152(1): 90-95.
19. Beard DJ, Davies LJ, Cook JA, et al. The clinical and cost-effectiveness of total versus partial knee replacement in patients with medial compartment osteoarthritis (TOPKAT): 5-year outcomes of a randomised controlled trial. Lancet, 2019, 394(10200): 746-756.
20. 中華醫學會骨科學分會關節外科學組, 中國醫師協會骨科醫師分會骨關節炎學組, 國家老年疾病臨床醫學研究中心(湘雅醫院), 等. 中國骨關節炎診療指南(2021年版). 中華骨科雜志, 2021, 41(18): 1291-1314.
21. Bilbao A, Martín-Fernández J, García-Pérez L, et al. Mapping WOMAC onto the EQ-5D-5L utility index in patients with hip or knee osteoarthritis. Value Health, 2020, 23(3): 379-387.
22. 彭浩彬, 溫嘉筠, 吳先平, 等. 布比卡因脂質體的臨床應用與爭議性. 中國醫藥指南, 2024, 22(21): 54-57.
23. Thijssen M, Timmerman L, Koning NJ, et al. Multimodal analgesia practices for knee and hip arthroplasties in the Netherlands. A prospective observational study from the PAIN OUT registry. PLoS One, 2022, 17(12): e0279606. doi: 10.1371/journal.pone.0279606.
24. 沈彬, 翁習生, 廖刃, 等. 中國髖、膝關節置換術加速康復——圍術期疼痛與睡眠管理專家共識. 中華骨與關節外科雜志, 2016, 9(2): 91-97.
25. 周宗科, 翁習生, 曲鐵兵, 等. 中國髖、膝關節置換術加速康復——圍術期管理策略專家共識. 中華骨與關節外科雜志, 2016, 9(1): 1-9.
26. Felson D. Tramadol and mortality in patients with osteoarthritis. JAMA, 2019, 322(5): 465-466.
27. Curtis GB, Johnson GH, Clark P, et al. Relative potency of controlled-release oxycodone and controlled-release morphine in a postoperative pain model. Eur J Clin Pharmacol, 1999, 55(6): 425-429.
28. Takahashi M, Ohara T, Yamanaka H, et al. The oral-to-intravenous equianalgesic ratio of morphine based on plasma concentrations of morphine and metabolites in advanced cancer patients receiving chronic morphine treatment. Palliat Med, 2003, 17(8): 673-678.
29. Swarm RA, Paice JA, Anghelescu DL, et al. Adult cancer pain, version 3. 2019, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2019, 17(8): 977-1007.
30. 曹卉娟, 邢建民, 劉建平. 視覺模擬評分法在癥狀類結局評價測量中的應用. 中醫雜志, 2009, 50(7): 600-602.
31. Chen JJ, Wu YC, Hung CY, et al. Effects of periarticular multimodal drug injection on pain control, early mobilization, and length of hospital stay in patients undergoing total knee arthroplasty. Life (Basel), 2024, 14(8): 1018. doi: 10.3390/life14081018.
32. Quaye A, McAllister B, Garcia JR, et al. A prospective, randomized trial of liposomal bupivacaine compared to conventional bupivacaine on pain control and postoperative opioid use in adults receiving adductor canal blocks for total knee arthroplasty. Arthroplasty, 2024, 6(1): 6. doi: 10.1186/s42836-023-00226-y.
33. Bedard NA, DeMik DE, Dowdle SB, et al. Trends and risk factors for prolonged opioid use after unicompartmental knee arthroplasty. Bone Joint J, 2018, 100-B(1 Supple A): 62-67.
34. Malige A, Pellegrino AN, Kunkle K, et al. Liposomal bupivacaine in adductor canal blocks before total knee arthroplasty leads to improved postoperative outcomes: A randomized controlled trial. J Arthroplasty, 2022, 37(8): 1549-1556.
35. Bagsby DT, Ireland PH, Meneghini RM. Liposomal bupivacaine versus traditional periarticular injection for pain control after total knee arthroplasty. J Arthroplasty, 2014, 29(8): 1687-1690.
36. Chen JJ, Wu YC, Wang JS, et al. Liposomal bupivacaine administration is not superior to traditional periarticular injection for postoperative pain management following total knee arthroplasty: a meta-analysis of randomized controlled trials. J Orthop Surg Res, 2023, 18(1): 206. doi: 10.1186/s13018-023-03699-4.
37. 李俊, 李智平. 脂質體布比卡因減少全膝關節置換術后疼痛有效性的meta分析. 中華骨與關節外科雜志, 2019, 12(4): 285-289.
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Chinese Journal of Reparative and Reconstructive Surgery

Observation of analgesic efficacy of liposomal bupivacaine for local infiltration anesthesia in unicompartmental knee arthroplasty: a prospective randomized controlled study

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