The journal of knee surgery
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When orthopedists consider which analgesia to use after total knee arthroplasty (TKA), the primary objective is to relieve pain with fewer adverse side effects. Over the last decade, substantial efforts have been made to improve pain control following TKA, but it is still very challenging to obtain optimal control. ⋯ Recently, bupivacaine, a commonly used nonopioid analgesic, has been formulated into an aqueous suspension of multivesicular liposomes that provide long-lasting analgesia, while avoiding significant adverse effects of opioids. The purpose of this review is to analyze the use of traditional postsurgical pain management and the potential contribution of a long-acting liposomal formulation of bupivacaine as part of the analgesic regimen in TKA, including its mode of action, injection technique, efficacy on pain, and health care costs.
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Comparative Study
Liposomal Bupivacaine Suspension Can Reduce Lengths of Stay and Improve Discharge Status of Patients Undergoing Total Knee Arthroplasty.
The purpose of this study was to use a large hospital database to assess: (1) length of hospital stay (LOS) and (2) discharge status among patients undergoing total knee arthroplasty (TKA) with or without the use of a liposomal bupivacaine suspension injection. We utilized an all-payer hospital administrative database from July 1, 2013 to June 30, 2014. We then selected patients age 18 years or older who had an inpatient stay for TKA in the data window based on International Classification of Diseases, Ninth Revision (ICD-9) procedure codes (ICD-9-CM = 81.54), which resulted in 103,152 TKA patients. ⋯ Patients who underwent TKA with liposomal bupivacaine had a significantly shorter LOS and a higher likelihood of being discharged to home. These results suggest that liposomal bupivacaine may represent a promising addition to current pain management regimens. Furthermore, it may limit pain following surgery, which may allow patients to ambulate earlier and have improved outcomes.
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Unicompartmental medial knee arthritis can be successfully treated with either unicompartmental or total knee arthroplasty (UKA or TKA). Active patients often inquire about the relative likelihood of returning to a sport-related activity after surgery. ⋯ We identified 33 patients with UKA and 39 patients with TKA with minimum 2-year follow-up (4 ± 1.2 years) who had similar preoperative clinical and radiographic examinations. Clinical evaluation revealed no difference in the number of patients who returned to sports or their satisfaction, but patients with UKA returned to sports more quickly and exhibited better postoperative knee scores than TKA patients.