Liposomal Bupivacaine Offers No Benefit Over Ropivacaine for Multimodal Periarticular Injection in Total Knee Arthroplasty

Local infiltration analgesia has become a mainstay of pain control for total knee arthroplasty. This study compared the efficacy and cost between periarticular injection cocktails containing liposomal bupivacaine vs ropivacaine. Two hundred forty-two primary total knee arthroplasties performed between September 2013 and January 2016 were retrospectively reviewed. All patients received similar pre-operative medications and a periarticular injection. The control group received 300 mg of ropivacaine, while the study group received liposomal bupivacaine. All patients received the same preoperative, intraoperative, and postoperative adjunct medications. Visual analog scale pain scores, narcotic requirements, distance walked, range of motion, length of stay, Knee Society Scores, and need for manipulation under anesthesia were recorded. Mean visual analog scale pain score 23 to 32 hours postoperatively, mean visual analog scale pain score during the entire hospitalization, and length of stay were lower in the ropivacaine group compared with the liposomal bupivacaine group. Knee range of motion was higher at 2 weeks in the ropivacaine group. There were no statistically significant differences in the other outcome measures. The cost of ropivacaine was considerably lower than the cost of liposomal bupivacaine. Bupivacaine added to liposomal bupivacaine addressed the delayed onset of this medication and gave an accurately matched comparison with the ropivacaine cocktail. All outcomes tested with liposomal bupivacaine were either equivalent or inferior to those with ropivacaine. When used as a component of a periarticular injection cocktail, liposomal bupivacaine offers no advantages over ropivacaine and has a considerably higher cost. [ Orthopedics . 2020; 43(2):91–96.]