SAN ANTONIO— The intraoperative addition of bupivacaine liposome injectable improves clinical outcomes compared with traditional local anesthetic cocktails in patients undergoing total knee arthroplasty (TKA), according to research presented at the 2016 annual meeting of the American Academy of PAs (AAPA).

Patients who received the bupivacaine liposome injectable suspension were able to ambulate farther and were discharged slightly sooner compared with patients who received standard local anesthetic intraoperatively.  These findings further support multimodal approaches to pain management and to decrease reliance on opioid treatment. 

The study included 104 patients who had been diagnosed with knee osteoarthritis and were scheduled for TKA with one of 2 surgeons (surgeon A or surgeon B) from February 2015 to September 2015. Patients were grouped by age into 4 groups: <60 years, 61 to 70 years, 71 to 80 years, and >80 years. The researchers recorded pain control, ambulation on POD 0, total ambulation distance, length of stay, and discharge to home versus discharge to extended care facility.

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Preoperatively, all patients were administered one dose of oral celecoxib at 200 mg, oral oxycodone sustained release at 10 mg, and oral gabapentin at 300 mg.

Intraoperatively, all patients underwent spinal anesthesia with an adductor canal nerve block at case end. Patients of surgeon A (n=58) were also administered 20 mL of bupivacaine liposome injectable (266 mg/mL) with 50 mL of bupivacaine 0.25%, for a total volume of 70 mL. Patients of surgeon B (n=46) were administered 30 mL of ropivacaine 0.5%, 20 mL of lidocaine 0.5%, and 1 mL of ketorolac (30 mg), for a total of 51 mL of local anesthetic.

Postoperatively, all patients received scheduled analgesia with oral celecoxib at 200 mg daily for 10 days, ketorolac at 15 to 30 mg intravenously every 6 hours (3 doses), acetaminophen at 1000 mg intravenously every 8 hours (2 doses), and oral gabapentin at 300 mg daily at night until discharge.

Other pain medication was dispensed as needed, including oral oxycodone immediate release at 5 mg every 3 hours for moderate pain, oral oxycodone immediate release at 10 mg every 3 hours for severe pain, and oral oxycodone immediate release at 5 mg twice daily before physical therapy (not given within 40 minutes of prior narcotic administration).

Pain was well-controlled in 83% of surgeon A’s patients and in 89% of surgeon B’s patients. Patients in group A were able to ambulate farther on POD 0 (mean, 17.1 feet) compared with patients in group B (mean, 10.5 feet). Over one session, patients in group A ambulated greater distances (mean, 317 feet) compared with patients in group B (mean, 273 feet).

Patients in group A had an average length of stay that was 0.3 days less than patients in group B. In group A, 74% of patients were discharged to home during the study period, compared with 57% in group B.


  1. Mackey KA, Bach D, Canet D. Multimodal pain management in total knee arthroplasty: An introduction of bupivacaine liposome injectable suspension intraoperatively. ePoster presented at: 2016 annual meeting of the American Academy of PAs (AAPA); May 14-18, 2016; San Antonio, TX.

This article originally appeared on Clinical Advisor