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Abstract
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Background and Aims Multimodal analgesia is effective way to treat postsurgical pain. Routine Opiate use for acute pain management leads to delayed discharge and for enhanced recovery we need to reserve opiates for rescue analgesia. Liposomal Bupivacaine prolongs efficacy and duration of action and helps achieve Drink Rest Eat Analgesia Mobilise (DREAM) recovery post knee replacement . FDA license for Single-dose infiltration was given in 2011 and subsequently for Brachial plexus block, fascial plane, post surgical wound infiltration. In 2023 FDA approved Liposomal Bupivacaine for adductor canal block and sciatic nerve block.
Methods Data collected from 20 patients who underwent Total knee replacement ( TKR ) with 20 mls 266 (mg ) Liposomal Bupivacaine injcted under USG guidance for nerve infiltration in Adductor canal and IPACK ( Posterior capsule) compared with 20 patients who underwent TKR with standard technique of plain Bupivacaine local infiltration .Both sets of Patients were also given central neuraxial blockade with 0.5% Hyperbaric Bupivacaine 2.5 mls. A reduction in cumulative pain scores and opiate consumption postoperatively were end points.
Results Treatment with Liposomal Bupivacaine met the primary endpoint demonstrating significant 0 to 96 hours compared with bupivacaine hydrochloride (P <.01). Moreover,it was associated with a statistically significant reduction in postsurgical opioid consumption through 96 hours (P <.01). Statistical significance was achieved for the percentage of opioid-free patients who received Liposomal bupivacaine as a Adductor canal block through 96 hours (P <.01).
History of Liposomal Bupivacaine
Adductor canal infiltration
IPACK
Conclusions Peripheral nerve block with liposomal bupivacaine provides superior analgesia to local infiltration. Enhanced recovery DREAM fulfiled by Liposomal Bupivacaine.