Liposomal bupivacaine surgical site injection for decrease of narcotic use in hip fractures: a pilot multicenter...

Area of Science:

• Orthopedic Surgery
• Anesthesiology
• Geriatric Medicine

Background:

• Geriatric hip fractures are common, leading to significant pain and potential postoperative complications like delirium.
• Effective pain management is crucial for recovery and reducing morbidity in this population.
• Liposomal bupivacaine offers prolonged local anesthesia, but its efficacy in fragility hip fractures is not well-established.

Purpose of the Study:

• To evaluate the effectiveness of liposomal bupivacaine compared to placebo for pain management in patients over 55 undergoing surgery for hip fractures.
• To inform the design of a larger trial by assessing effect size and feasibility.

Main Methods:

• A double-blinded, multicenter randomized controlled trial was conducted.
• Patients over 55 with isolated fragility hip fractures received either liposomal bupivacaine or a saline placebo.
• Primary outcome was opioid use; secondary outcomes included pain scores, delirium assessment, and complications.

Main Results:

• No statistically significant differences were observed in opioid use, pain scores, or delirium between the liposomal bupivacaine and placebo groups at 24, 48, or 72 hours.
• Data collection at 72 hours was not feasible, but 48-hour data collection achieved 89% completion.
• A sample size of 518 patients would be required for a superiority trial to detect a 20% difference in opioid use.

Conclusions:

• Liposomal bupivacaine did not demonstrate a clinical advantage over placebo for pain control or delirium reduction in geriatric hip fracture patients.
• The study suggests that a small effect size, if present, may not justify the medication's cost and complexity for a larger trial.
• Further investigation into liposomal bupivacaine for this indication is not recommended based on these findings.