Intraoperative Liposomal Bupivacaine Is Associated With Reduced Opioid Use and Enhanced Recovery After Total Knee...

With an annual volume of total knee arthroplasties (TKAs) in the United States projected to exceed 1.5 million by 2050, optimizing perioperative pain control and facilitating early discharge remain clinical priorities. This study evaluated the effectiveness of liposomal bupivacaine (LB) vs conventional bupivacaine/ropivacaine in opioid-naïve patients undergoing primary TKA, comparing/contrasting: (1) pain score improvements, (2) opioid usages, (3) functional recoveries, and (4) hospital lengths of stay.

Data from the Innovations in Genicular Outcomes Research (iGOR) registry were used to identify patients undergoing unilateral primary TKA between September 2021 and December 2024. Two hundred twenty-five patients were analyzed, 42 receiving LB and 183 receiving conventional local anesthetics. Patients were stratified based on intraoperative analgesia; pain was assessed using the Brief Pain Inventory-Short Form; opioid use was self-reported; function was measured with the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement. Comparative analyses were performed using generalized linear mixed-effects regressions, with significance P < .05.

The LB group showed lower average Brief Pain Inventory-Short Form scores in the early postoperative period (2.6 vs 2.9; P = .03), reduced opioid use at 3 months (24 vs 41%; P < .001), and improved Knee Injury and Osteoarthritis Outcome Score for Joint Replacement scores (65.2 vs 63.9; P = .004). Patients receiving LB were discharged 5.6 hours earlier than controls (15.0 vs 20.6 hours; P = .007).

Use of LB is associated with improved pain control, reduced opioid use, and shorter lengths of stay following TKA. This study highlights LB's utility in facilitating early mobilization and advancing perioperative care.