• Elizabeth L Dale, Chase T Kluemper, S Justin Cowart, Marshall Jemison, J Woody Kennedy, Lani Gao, Mark A Brzezienski, and Jason Rehm.
• Department of Plastic Surgery, University of Tennessee College of Medicine, Chattanooga, TN.
• J Hand Surg Am. 2020 Jun 1; 45 (6): 550.e1-550.e8.

PurposeThis study evaluated pain control after wrist operations using a long-acting local anesthetic, liposomal bupivacaine, compared with the standard local anesthetic, bupivacaine HCl.MethodsPatients undergoing elective carpometacarpal joint arthroplasty and proximal row carpectomy were eligible. Those meeting inclusion criteria were enrolled before surgery and were randomized to receive an intraoperative injection of liposomal bupivacaine or bupivacaine HCl. Primary outcomes included intraoperative and postoperative opioid requirements and pain levels. On the first 4 postoperative days, phone contact assessed pain level by numeric rating scale, number of opioids taken in each 24-hour period, and efficacy of anesthesia and opioid side effects with overall benefit of analgesia score.ResultsPostoperative pain scores for 52 patients measured by numeric rating scale demonstrated that liposomal bupivacaine and bupivacaine HCl were similar for pain control. Pain scores and opioid use were similar during the first 4 postoperative days. Opioid use on day 1 was slightly lower with liposomal bupivacaine. There were no statistically significant differences in any postoperative outcome between groups.ConclusionsLiposomal bupivacaine and bupivacaine HCl have similar effects in the treatment of early postoperative pain after trapeziometacarpal suspension arthroplasty and proximal row carpectomy. Neither drug demonstrated a clear advantage in this study.Type Of Study/Level Of EvidenceTherapeutic II.Copyright © 2020 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

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