Health Problem: Fewer than half of the 70 million patients who undergo surgery in the United States every year 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. Increasing awareness of issues on the safety of opioids has prompted a focus on best practices in multimodal analgesic regimens. For postoperative use, traditional local anesthetics are limited by their short duration of action. Bupivacaine is a long-acting amide local anesthetic. In the United States, an estimated 54.4 million adults have some form of arthritis or chronic joint symptoms with a projected prevalence of almost 80 million by the year 2040. In 2010, approximately 320,000 individuals underwent total hip arthroplasty (THA), and 53,000 had total shoulder arthroplasty (TSA).

Technology Description: Liposomal bupivacaine (LB) comprises the amide-type local anesthetic bupivacaine 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 (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 THA and TSA?

  • 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 THA or TSA?

  • How does PAI of LB compare with other types of analgesia with respect to safety in patients undergoing THA or TSA?

  • Have definitive patient selection criteria for PAI of LB in patients undergoing THA or TSA been established?

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