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#36155 The use of exparel in knee arthroplasty: a service improvement project
  1. Keable Samuel Nigel,
  2. Stolady Daniel,
  3. Fox Benjamin and
  4. Ivanov Ognyan
  1. Anaesthesia, Queen Elizabeth Hospital Kings Lynn, Kings Lynn, UK


Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)

Background and Aims Total Knee Arthroplasty (TKA) remains a painful procedure, requiring a multi-modal analgesic approach. There is a push for day case surgery due to the associated poorer mortality and morbidity that comes with increased length of stay; as well as the greater cost. To facilitate day case TKA, long- acting analgesic strategies such as perineural catheters and modified release opioids are looked upon. Exparel is a long-acting liposomal bupivacaine that has the potential to take the place of these aforementioned techniques. As part of a service improvement project we introduced Exparel in patients receiving a TKA and assessed impact upon length of stay.

Methods At our hospital patients undergoing elective knee arthroplasty are normally given spinal or general anaesthetic plus a combination of blocks; sub- sartorial +/- anterior-cutaneous nerves of the thigh +/- iPACK, adductor hiatus blocks or posterior surgical infiltration. We substituted 20mls of levobupivacaine for 20mls of Exparel. We then looked at post-operative length of stay.

Results 10 patients undergoing elective total knee arthroplasty received levobupivacaine/Exparel mixture and had an average length of stay of 1.8 days. This is in contrast to our Model Hospital data for 2022/23 which shows an average length of stay of 3.4 days.

Conclusions The addition of Exparel reduced our average length of stay which is in keeping with a study by Malige et al. We plan to continue the TKA service improvement project in an attempt to find the best analgesic strategy that facilitates same day discharge.

Attachment Exparel – HRA decision tool – not research.pdf

  • exparel
  • knee
  • arthroplasty

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