Liposomal Bupivacaine for Post-Operative Pain Control in Fragility Intertrochanteric Hip Fractures

OBJECTIVES:

Determine whether intraoperative liposomal bupivacaine reduces postoperative opioid requirements, pain scores, and length of stay in patients with fragility intertrochanteric femur fractures in comparison to a group of patients who did not receive liposomal bupivacaine.

DESIGN:

Retrospective Observational Study SETTING:: Two Academic Medical Centers PATIENTS:: 102 patients with intertrochanteric hip fracture treated with a cephalomedullary nail implant INTERVENTION:: Non-randomized administration of liposomal bupivacaine in two cohorts of patients with similar injuries and treatment MAIN OUTCOME MEASUREMENTS:: Post-operative oral average morphine equivalents (MME) and average numerical pain rating score (NRS). Secondary endpoints included postoperative length of stay (LOS), operative time, and home discharge.

RESULTS:

Forty-six patients received intraoperative liposomal bupivacaine and 56 patients did not. There was no significant difference between age, sex, and American Society of Anesthesiologist (ASA) level between groups (p>0.05). The liposomal bupivacaine group received significantly less MME (0.34 mg/h/kg vs 0.92 mg/h/kg, p=0.04) and had significantly lower NRS (2.89 vs 5.13, p=0.04) in the first 24 hours following surgery. MME (1.18 mg/h/kg vs 1.37 mg/h/kg, p=0.27) and NRS (3.61 vs 5.51, p=0.34) were similar at the 36-hour mark. The liposomal bupivacaine group had similar LOS (3.2 days vs 3.8, p=0.08), more home discharges (7 vs 2, p =0.001), and longer operative time (73.4 min vs 67.2min, p=0.004).

CONCLUSION:

Intraoperative liposomal bupivacaine use reduced opioid use and postoperative pain for the first 24 hours following fixation of intertrochanteric femur fractures. Significant increases in likelihood of discharge to home may present an opportunity for cost savings.

 2019 Oct 11. doi: 10.1097/BOT.0000000000001665. [Epub ahead of print]