Periarticular Injections with Liposomal Bupivacaine in Comparison with Traditional (Bupivacaine/Ropivacaine) Periarticular Injections in Total Hip Arthroplasty: A Systematic Review

Abstract

Objectives This systematic review aims to comprehensively evaluate the current literature to determine whether local infiltration liposomal bupivacaine (LB) used in total hip arthroplasty (THA) results in reduced pain scores and opioid consumption compared to traditional local anesthetics. Methods A systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using Ovid Medline, PubMed, Scopus, and ScienceDirect databases. Articles were screened independently by two investigators based on inclusion criteria of 1) prospective randomized control trials or retrospective cohort studies, 2) conducted after the 2015 Food and Drug Administration (FDA) expansion of LB indication to local surgical infiltration, 3) compared LB as a periarticular injection to other local anesthetics used as a periarticular injection, and 4) available in English. Primary outcomes of pain scores and opioid consumption were reported. Secondary outcomes of interest included mobility, length of stay, costs, incidence of adverse events, and readmission rates. Bupivacaine costs $3 per dose, while LB costs $334 per dose. Results A total of seven articles were identified with the inclusion criteria. Four studies concluded that LB improves patient outcomes of pain scores and opioid consumption in patients receiving THA. Three studies found no benefit to using LB compared to their controls. Four studies found no significant reduction in the length of stay between the groups. There were no reported differences in the incidence of adverse events or total costs between the two groups. Conclusion There are minimal benefits of reduced pain scores or opioid consumption when using LB opioid-sparing protocols compared to current protocols for patients undergoing THA. Level of Evidence III