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Comparative Effectiveness Review of Bupivacaine Liposome Injectable Suspension for Relief of Postoperative Pain Following Total Knee Arthroplasty: A Review of Reviews

August 2, 2018

Health Problem: More than 70 million surgical procedures are performed annually in the United States. Fewer than half of patients who undergo surgery report adequate postoperative pain relief. Controlling postoperative pain increases patient mobility, permits earlier return to activities of daily living, and reduces the risk for postoperative complications. According to 2010 statistics, the prevalence of total knee arthroplasty (TKA) in the United States has been estimated to be 1.52% in the overall population and 4.55% among adults ≥ 50 years of age. This represents approximately 4.7 million individuals treated by TKA (3.0 million women, 1.7 million men).

Technology Description: Liposomal bupivacaine (LB) comprises the amide-type local anesthetic bupivacaine hydrochloride (HCl) encapsulated within multivesicular liposomes to facilitate the slow, sustained release of bupivacaine to provide pain relief for up to 72 hours after surgery. LB is indicated for single-dose infiltration into the surgical site. LB is usually administered via periarticular infiltration or injection (PAI) prior to closing the surgical site.

Controversy: Controversial issues related to the clinical use of LB include safety and effectiveness versus other modalities, optimal mode of administration, and patient selection (i.e., which patients might benefit the most from the treatment).

Key Questions:

  • How does PAI of LB compare with other forms of analgesia for reducing pain and opioid consumption following TKA?
  • How does PAI of LB compare with other forms of analgesia with respect to postoperative function and rehabilitation outcomes, operating time and hospital length of stay, and patient satisfaction following TKA?
  • How does PAI of LB compare with other types of analgesia with respect to safety in patients undergoing TKA?
  • Have definitive patient selection criteria for PAI of LB in patients undergoing TKA been established?